Axiom Foundation

loading…

us/statute/42/1395w–102/b/2/E/v — Additional requirements · Axiom

(III)PDP sponsor and MA organization responsibilities#

Each PDP sponsor offering a prescription drug plan or MA organization offering an MA–PD plan—

(aa) may not limit the option for an enrollee to make such an election to certain covered part D drugs;

(bb) shall, prior to the plan year, notify prospective enrollees of the option to make such an election in promotional materials;

(cc) shall include information on such option in enrollee educational materials;

(dd) shall have in place a mechanism to notify a pharmacy during the plan year when an enrollee incurs out-of-pocket costs with respect to covered part D drugs that make it likely the enrollee may benefit from making such an election;

(ee) shall provide that a pharmacy, after receiving a notification described in item (dd) with respect to an enrollee, informs the enrollee of such notification;

(ff) shall ensure that such an election by an enrollee has no effect on the amount paid to pharmacies (or the timing of such payments) with respect to covered part D drugs dispensed to the enrollee; and

(gg) shall have in place a financial reconciliation process to correct inaccuracies in payments made by an enrollee under this subparagraph with respect to covered part D drugs during the plan year.

(III)(aa)#

may not limit the option for an enrollee to make such an election to certain covered part D drugs;

(III)(bb)#

shall, prior to the plan year, notify prospective enrollees of the option to make such an election in promotional materials;

(III)(cc)#

shall include information on such option in enrollee educational materials;

(III)(dd)#

shall have in place a mechanism to notify a pharmacy during the plan year when an enrollee incurs out-of-pocket costs with respect to covered part D drugs that make it likely the enrollee may benefit from making such an election;

(III)(ee)#

shall provide that a pharmacy, after receiving a notification described in item (dd) with respect to an enrollee, informs the enrollee of such notification;

(III)(ff)#

shall ensure that such an election by an enrollee has no effect on the amount paid to pharmacies (or the timing of such payments) with respect to covered part D drugs dispensed to the enrollee; and

(III)(gg)#

shall have in place a financial reconciliation process to correct inaccuracies in payments made by an enrollee under this subparagraph with respect to covered part D drugs during the plan year.

Additional requirements

(I)Secretarial responsibilities#

(II)Timing of election#

(II)(aa)#

(II)(bb)#

(III)PDP sponsor and MA organization responsibilities#

(III)(aa)#

(III)(bb)#

(III)(cc)#

(III)(dd)#

(III)(ee)#

(III)(ff)#

(III)(gg)#

(IV)Failure to pay amount billed#

(IV)(aa)#

(IV)(bb)#

(V)Clarification regarding past due amounts#

(VI)Treatment of unsettled balances#