§1395w–152 Miscellaneous provisions

Summary

The Secretary of Health and Human Services can relax some Part D rules to make sure people living in U.S. territories (not the 50 states or D.C.) can get drug coverage. A rule from the Social Security Amendments of 1967 applies to Parts C and D the same way it does to Parts A and B, and any Trust Fund references in that rule mean the Medicare Prescription Drug Account inside the Federal Supplementary Medical Insurance Trust Fund. For certain people named elsewhere in the law who, by the last day of a calendar quarter in 2010, had already gone past the 2010 initial drug coverage limit, the Secretary must pay $250 from that Medicare Prescription Drug Account by the 15th day of the third month after that quarter ends. Only one such payment is allowed per person. When checking how a prescription drug plan sponsor is doing, the Secretary must use methods to review complaints from enrollees who say they can’t get drugs because of drug management programs for at‑risk beneficiaries. For plan years starting on or after January 1, 2028, the Secretary must publish reports at least every two years until 2034 (and sometimes after) that, as far as possible, show trends and comparisons about payments, fees, participation, numbers, cost‑sharing, and dispensing volume for “essential retail pharmacies” versus other pharmacies. An essential retail pharmacy is not an affiliate and is the only retail pharmacy within 10 miles in a rural area, 2 miles in a suburban area, or 1 mile in an urban area. The Secretary must post a list of those pharmacies on the CMS website starting with plan year 2028. Drug plan sponsors and MA organizations must send lists of their affiliate pharmacies and, starting with plan year 2027, report incentive payments and other fees to the Secretary. The Secretary can carry out these rules by program instruction, and some normal paperwork rules do not apply. Starting within two years after February 3, 2026, and at least every two years after that, the Secretary must also publish reports on enforcement of certain access rules, but those reports cannot reveal identifiable people or trade secrets. Affiliates and pharmacy benefit managers are defined elsewhere in the law.