§1395w–152 Miscellaneous Provisions

Summary

The Secretary can relax rules when needed so people in U.S. territories (places other than the 50 States and D.C.) can get Medicare Part D drug coverage. A 1967 Social Security rule also applies to Parts C and D like it does to Parts A and B, and any Trust Fund references for drug coverage mean the Medicare Prescription Drug Account inside the Federal Supplementary Medical Insurance Trust Fund. For some people who, by the last day of a quarter in 2010, had already passed the 2010 initial coverage limit for Part D drugs, the Secretary must pay $250 from that Drug Account to the person by the 15th day of the third month after that quarter ends; each person gets only one such payment. When checking a plan’s quality, the Secretary must use or make screening methods to review complaints about people not getting drugs because of drug management programs for at‑risk beneficiaries. Starting with plan years that begin on January 1, 2028, the Secretary must publish reports at least every two years until 2034 (and sometimes after) about trends and comparisons on payments, fees, participation, numbers, cost‑sharing, and dispensing volume for “essential retail pharmacies” versus other pharmacies, and also compare findings between pharmacies in prescription drug plans (PDPs) and Medicare Advantage drug plans (MA–PDs). An “essential retail pharmacy” means a retail pharmacy that is not an affiliate and that has no other retail pharmacy within 10 miles in a rural area, 2 miles in a suburban area, or 1 mile in an urban area, as set by the Secretary. Each year starting in 2028 the Secretary will post a list of those pharmacies on the CMS website. PDP sponsors and MA organizations must give the Secretary lists of their affiliate pharmacies (starting 2028) and must report incentive payments and other fees to pharmacies beginning with plan year 2027, in the form and at the times the Secretary requires. The Secretary may use program instructions to carry these rules out and is not bound by Chapter 35 of title 44 for that work. The terms “affiliate” and “pharmacy benefit manager” use the meanings in section 1395w–112(h)(7). Finally, within 2 years after February 3, 2026 and at least every 2 years after that, the Secretary must publish a report on enforcement and oversight actions under section 1395w–104(b)(1); those reports cannot reveal identifiable individual or entity information that is not already public, nor trade secrets.