Application
Except as provided in subparagraph (E) or subparagraph (F), in applying subparagraph (A)—
(i)#
incurred costs shall only include costs incurred with respect to covered part D drugs for the annual deductible described in paragraph (1), for cost-sharing described in paragraph (2), and, for a year preceding 2025, for amounts for which benefits are not provided because of the application of the initial coverage limit described in paragraph (3), but does not include any costs incurred for covered part D drugs which are not included (or treated as being included) in the plan’s formulary;
(ii)#
subject to clause (iii), such costs shall be treated as incurred only if they are paid by the part D eligible individual (or by another person, such as a family member, on behalf of the individual) and the part D eligible individual (or other person) is not reimbursed through insurance or otherwise, a group health plan, or other third-party payment arrangement (other than under such section or such a Program) for such costs; and
(iii)#
such costs shall be treated as incurred and shall not be considered to be reimbursed under clause (ii) if such costs—
(I) are borne or paid—— 1 1 So in original. (aa) under section 1395w–114 of this title ; (bb) under a State Pharmaceutical Assistance Program; (cc) by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 1603 of title 25 ); (dd) 2 2 So in original. There are two items (dd). under an AIDS Drug Assistance Program under part B of title XXVI of the Public Health Service Act [ 42 U.S.C. 300ff–21 et seq.]; or (dd) 2 under section 1395w–115(h) of this title ; or
(II) for 2025 and subsequent years, are reimbursed through insurance, a group health plan, or certain other third party payment arrangements, but not including the coverage provided by a prescription drug plan or an MA–PD plan that is basic prescription drug coverage (as defined in subsection (a)(3)) or any payments by a manufacturer under the manufacturer discount program under section 1395w–114c of this title .
(iii)(I)#
are borne or paid—— 1 1 So in original.
(aa) under section 1395w–114 of this title ;
(bb) under a State Pharmaceutical Assistance Program;
(cc) by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 1603 of title 25 );
(dd) 2 2 So in original. There are two items (dd). under an AIDS Drug Assistance Program under part B of title XXVI of the Public Health Service Act [ 42 U.S.C. 300ff–21 et seq.]; or
(dd) 2 under section 1395w–115(h) of this title ; or