42 U.S.C. § 1395w–151 — Definitions; treatment of references to provisions in part C

1. (a)DefinitionsFor purposes of this part:
   1. (1)Basic prescription drug coverageThe term “basic prescription drug coverage” is defined in section 1395w–102(a)(3) of this title.
   2. (2)Covered part D drugThe term “covered part D drug” is defined in section 1395w–102(e) of this title.
   3. (3)Creditable prescription drug coverageThe term “creditable prescription drug coverage” has the meaning given such term in section 1395w–113(b)(4) of this title.
   4. (4)Part D eligible individualThe term “part D eligible individual” has the meaning given such term in section 1395w–101(a)(3)(A) of this title.1 See References in Text note below.
   5. (5)Fallback prescription drug planThe term “fallback prescription drug plan” has the meaning given such term in section 1395w–111(g)(4) of this title.
   6. (6)Initial coverage limitThe term “initial coverage limit” means such limit as established under section 1395w–102(b)(3) of this title for a year before 2025, or, in the case of coverage that is not standard prescription drug coverage, the comparable limit (if any) established under the coverage for such year.
   7. (7)Insurance riskThe term “insurance risk” means, with respect to a participating pharmacy, risk of the type commonly assumed only by insurers licensed by a State and does not include payment variations designed to reflect performance-based measures of activities within the control of the pharmacy, such as formulary compliance and generic drug substitution.
   8. (8)MA planThe term “MA plan” has the meaning given such term in section 1395w–101(a)(3)(B) of this title.1
   9. (9)MA–PD planThe term “MA–PD plan” has the meaning given such term in section 1395w–101(a)(3)(C) of this title.1
   10. (10)Medicare Prescription Drug AccountThe term “Medicare Prescription Drug Account” means the Account created under section 1395w–116(a) of this title.
   11. (11)PDP approved bidThe term “PDP approved bid” has the meaning given such term in section 1395w–113(a)(6) of this title.
   12. (12)PDP regionThe term “PDP region” means such a region as provided under section 1395w–111(a)(2) of this title.
   13. (13)PDP sponsorThe term “PDP sponsor” means a nongovernmental entity that is certified under this part as meeting the requirements and standards of this part for such a sponsor.
   14. (14)Prescription drug planThe term “prescription drug plan” means prescription drug coverage that is offered—
       1. (A)under a policy, contract, or plan that has been approved under section 1395w–111(e) of this title; and
       2. (B)by a PDP sponsor pursuant to, and in accordance with, a contract between the Secretary and the sponsor under section 1395w–112(b) of this title.
   15. (15)Qualified prescription drug coverageThe term “qualified prescription drug coverage” is defined in section 1395w–102(a)(1) of this title.
   16. (16)Standard prescription drug coverageThe term “standard prescription drug coverage” is defined in section 1395w–102(b) of this title.
   17. (17)State Pharmaceutical Assistance ProgramThe term “State Pharmaceutical Assistance Program” has the meaning given such term in section 1395w–133(b) of this title.
   18. (18)Subsidy eligible individualThe term “subsidy eligible individual” has the meaning given such term in section 1395w–114(a)(3)(A) of this title.
2. (b)Application of part C provisions under this partFor purposes of applying provisions of part C under this part with respect to a prescription drug plan and a PDP sponsor, unless otherwise provided in this part such provisions shall be applied as if—
   1. (1)any reference to an MA plan included a reference to a prescription drug plan;
   2. (2)any reference to an MA organization or a provider-sponsored organization included a reference to a PDP sponsor;
   3. (3)any reference to a contract under section 1395w–27 of this title included a reference to a contract under section 1395w–112(b) of this title;
   4. (4)any reference to part C included a reference to this part; and
   5. (5)any reference to an election period under section 1395w–21 of this title were a reference to an enrollment period under section 1395w–101 of this title.