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136 STAT. 1893 PUBLIC LAW 117–169—AUG. 16, 2022 SEC. 11202. MAXIMUM MONTHLY CAP ON COST-SHARING PAYMENTS UNDER PRESCRIPTION DRUG PLANS AND MA–PD PLANS. (a) IN GENERAL.—Section 1860D–2(b) of the Social Security Act (42 U.S.C. 1395w–102(b)) is amended— (1) in paragraph (2)— (A) in subparagraph (A), by striking ‘‘and (D)’’ and inserting ‘‘, (D), and (E)’’; and (B) by adding at the end the following new subpara- graph: ‘‘(E) MAXIMUM MONTHLY CAP ON COST-SHARING PAY- MENTS.— ‘‘(i) IN GENERAL.—For plan years beginning on or after January 1, 2025, each PDP sponsor offering a prescription drug plan and each MA organization offering an MA–PD plan shall provide to any enrollee of such plan, including an enrollee who is a subsidy eligible individual (as defined in paragraph (3) of sec- tion 1860D–14(a)), the option to elect with respect to a plan year to pay cost-sharing under the plan in monthly amounts that are capped in accordance with this subparagraph. ‘‘(ii) DETERMINATION OF MAXIMUM MONTHLY CAP.— For each month in the plan year for which an enrollee in a prescription drug plan or an MA–PD plan has made an election pursuant to clause (i), the PDP sponsor or MA organization shall determine a max- imum monthly cap (as defined in clause (iv)) for such enrollee. ‘‘(iii) BENEFICIARY MONTHLY PAYMENTS.—With respect to an enrollee who has made an election pursu- ant to clause (i), for each month described in clause (ii), the PDP sponsor or MA organization shall bill such enrollee an amount (not to exceed the maximum monthly cap) for the out-of-pocket costs of such enrollee in such month. ‘‘(iv) MAXIMUM MONTHLY CAP DEFINED.—In this subparagraph, the term ‘maximum monthly cap’ means, with respect to an enrollee— ‘‘(I) for the first month for which the enrollee has made an election pursuant to clause (i), an amount determined by calculating— ‘‘(aa) the annual out-of-pocket threshold specified in paragraph (4)(B) minus the incurred costs of the enrollee as described in paragraph (4)(C); divided by ‘‘(bb) the number of months remaining in the plan year; and ‘‘(II) for a subsequent month, an amount deter- mined by calculating— ‘‘(aa) the sum of any remaining out-of- pocket costs owed by the enrollee from a pre- vious month that have not yet been billed to the enrollee and any additional out-of- pocket costs incurred by the enrollee; divided by ‘‘(bb) the number of months remaining in the plan year. Effective date. VerDate Sep 11 2014 13:57 Oct 25, 2022 Jkt 029139 PO 00169 Frm 00077 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL169.117 PUBL169 jmbennett on LAP3P8D0R2PROD with Publaw