§1395w–134 Coordination Requirements for Plans Providing Prescription Drug Coverage

Summary

The Secretary must apply the benefit coordination rules in 1395w–133(a) to certain prescription drug plans (called Rx plans) the same way those rules apply to a State Pharmaceutical Assistance Program. To the extent the Secretary says, those rules also apply to the procedures in 1395w–102(b)(4)(D). The Secretary may charge user fees to send the information needed for coordination under 1395w–102(b)(4)(D), similar to fees under 1395u(h)(3)(B), and may keep part of those fees to cover costs. The Secretary may not charge those fees to a State Pharmaceutical Assistance Program. An Rx plan means any of the following: a Medicaid state plan under subchapter XIX (including a plan operating under a section 1315 waiver) that meets 1395w–133(b)(2); an employer group health plan; the Federal Employees Health Benefits Program under chapter 89 of title 5; military coverage under chapter 55 of title 10 (including TRICARE); or other drug coverage or financial help for Part D eligible people that the Secretary specifies. These rules do not stop PDP sponsors or MA organizations from using cost management tools (including differential payments) under any method of operation, and they do not change how the procedures in 1395w–102(b)(4)(D) are applied.