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

Summary

The Secretary must use the same rules for coordinating prescription drug benefits for certain drug plans that are used for State Pharmaceutical Assistance Programs. Those coordination rules also apply, as the Secretary says, to the information‑sharing procedures for benefit coordination. The Secretary may charge fees to send that information and can keep part of the fees to cover costs, but cannot charge those fees to a State Pharmaceutical Assistance Program. The rule covers five kinds of drug plans: Medicaid state plans (including some waivers) that meet specific rules, employer group health plans, the Federal Employees Health Benefits Program, coverage under chapter 55 of title 10, and other plans the Secretary names. These requirements do not stop plan sponsors or Medicare Advantage organizations from using cost controls, and they do not change the stated information‑sharing procedures.