Coverage for generic drugs in coverage gap
(i) In general
(i)In general#
Except as provided in paragraphs (4), (8), and (9), for a year preceding 2025, the coverage for an applicable beneficiary (as defined in section 1395w–114a(g)(1) of this title ) has coinsurance (for costs above the initial coverage limit under paragraph (3) and below the out-of-pocket threshold) for covered part D drugs that are not applicable drugs under section 1395w–114a(g)(2) of this title that is—
(I) equal to the generic-gap coinsurance percentage (specified in clause (ii)) for the year; or
(II) actuarially equivalent (using processes and methods established under section 1395w–111(c) of this title ) to an average expected payment of such percentage of such costs for covered part D drugs that are not applicable drugs under section 1395w–114a(g)(2) of this title .
(i)(I)#
equal to the generic-gap coinsurance percentage (specified in clause (ii)) for the year; or
(i)(II)#
actuarially equivalent (using processes and methods established under section 1395w–111(c) of this title ) to an average expected payment of such percentage of such costs for covered part D drugs that are not applicable drugs under section 1395w–114a(g)(2) of this title .
(ii)Generic-gap coinsurance percentage#
The generic-gap coinsurance percentage specified in this clause for—
(I) 2011 is 93 percent;
(II) 2012 and each succeeding year before 2020 is the generic-gap coinsurance percentage under this clause for the previous year decreased by 7 percentage points; and
(III) 2020 through 2024 is 25 percent.
(ii)(I)#
2011 is 93 percent;
(ii)(II)#
2012 and each succeeding year before 2020 is the generic-gap coinsurance percentage under this clause for the previous year decreased by 7 percentage points; and
(ii)(III)#
2020 through 2024 is 25 percent.