§1395w–103 Access to a Choice of Qualified Prescription Drug Coverage

Summary

The Secretary must make sure every person eligible for Part D has at least 2 qualifying plans available where they live, and at least one must be a prescription drug plan. If those plans are not available, the person can enroll in a fallback prescription drug plan. If all the qualifying plans in an area are offered by the same company, that does not meet the rule; plans must come from different sponsors. A “qualifying plan” means either a prescription drug plan (PDP) or an MA–PD plan described in section 1395w–21(a)(2)(A)(i) that gives basic drug coverage or qualified supplemental drug coverage without an MA monthly supplemental beneficiary premium because of a rebate credit under section 1395w–24(b)(1)(C). To help meet access, the Secretary may approve limited risk plans under section 1395w–111(f), and only if access still fails, must offer a fallback PDP under section 1395w–111(g).