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136 STAT. 1903 PUBLIC LAW 117–169—AUG. 16, 2022 respect to a covered insulin product under a prescription drug plan or an MA–PD plan dispensed— ‘‘(i) during plan years 2023, 2024, and 2025, $35; and ‘‘(ii) during plan year 2026 and each subsequent plan year, the lesser of— ‘‘(I) $35; ‘‘(II) an amount equal to 25 percent of the maximum fair price established for the covered insulin product in accordance with part E of title XI; or ‘‘(III) an amount equal to 25 percent of the negotiated price of the covered insulin product under the prescription drug plan or MA–PD plan. ‘‘(E) SPECIAL RULE FOR FIRST 3 MONTHS OF 2023.—With respect to a month’s supply of a covered insulin product dispensed during the period beginning on January 1, 2023, and ending on March 31, 2023, a PDP sponsor offering a prescription drug plan or an MA organization offering an MA–PD plan shall reimburse an enrollee within 30 days for any cost-sharing paid by such enrollee that exceeds the cost-sharing applied by the prescription drug plan or MA–PD plan under subparagraph (B)(i) at the point-of- sale for such month’s supply.’’; and (2) in subsection (c), by adding at the end the following new paragraph: ‘‘(6) TREATMENT OF COST-SHARING FOR COVERED INSULIN PRODUCTS.—The coverage is provided in accordance with sub- section (b)(9).’’. (b) CONFORMING AMENDMENTS TO COST-SHARING FOR LOW- INCOME INDIVIDUALS.—Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)), as amended by sections 11201, 11401, and 11404, is amended— (1) in paragraph (1)— (A) in subparagraph (D)(iii), by adding at the end the following new sentence: ‘‘For plan year 2023 and subse- quent plan years, the copayment amount applicable under the preceding sentence to a month’s supply of a covered insulin product (as defined in section 1860D–2(b)(9)(C)) dispensed to the individual may not exceed the applicable copayment amount for the product under the prescription drug plan or MA–PD plan in which the individual is enrolled.’’; and (B) in subparagraph (E), by inserting the following before the period at the end: ‘‘or under section 1860D– 2(b)(9) in the case of a covered insulin product (as defined in subparagraph (C) of such section)’’; and (2) in paragraph (2)— (A) in subparagraph (B), by striking ‘‘section 1860D– 2(b)(8)’’ and inserting ‘‘paragraphs (8) and (9) of section 1860D–2(b)’’; (B) in subparagraph (D), by adding at the end the following new sentence: ‘‘For plan year 2023, the amount of the coinsurance applicable under the preceding sentence to a month’s supply of a covered insulin product (as defined in section 1860D–2(b)(9)(C)) dispensed to the individual may not exceed the applicable copayment amount for the Time periods. Reimbursement. Deadline. VerDate Sep 11 2014 13:57 Oct 25, 2022 Jkt 029139 PO 00169 Frm 00087 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL169.117 PUBL169 jmbennett on LAP3P8D0R2PROD with Publaw