§ 1395w–151. Definitions; treatment of references to provisions in part C

• (a) For purposes of this part:
  • (1) The term “basic prescription drug coverage” is defined in section 1395w–102(a)(3) of this title .
  • (2) The term “covered part D drug” is defined in section 1395w–102(e) of this title .
  • (3) The term “creditable prescription drug coverage” has the meaning given such term in section 1395w–113(b)(4) of this title .
  • (4) The term “part D eligible individual” has the meaning given such term in section 1395w–101(a)(3)(A) of this title . 1 1 See References in Text note below.
  • (5) The term “fallback prescription drug plan” has the meaning given such term in section 1395w–111(g)(4) of this title .
  • (6) The term “initial coverage limit” means such limit as established under section 1395w–102(b)(3) of this title for a year before 2025, or, in the case of coverage that is not standard prescription drug coverage, the comparable limit (if any) established under the coverage for such year.
  • (7) The term “insurance risk” means, with respect to a participating pharmacy, risk of the type commonly assumed only by insurers licensed by a State and does not include payment variations designed to reflect performance-based measures of activities within the control of the pharmacy, such as formulary compliance and generic drug substitution.
  • (8) The term “MA plan” has the meaning given such term in section 1395w–101(a)(3)(B) of this title . 1
  • (9) The term “MA–PD plan” has the meaning given such term in section 1395w–101(a)(3)(C) of this title . 1
  • (10) The term “Medicare Prescription Drug Account” means the Account created under section 1395w–116(a) of this title .
  • (11) The term “PDP approved bid” has the meaning given such term in section 1395w–113(a)(6) of this title .
  • (12) The term “PDP region” means such a region as provided under section 1395w–111(a)(2) of this title .
  • (13) The term “PDP sponsor” means a nongovernmental entity that is certified under this part as meeting the requirements and standards of this part for such a sponsor.
  • (14) The term “prescription drug plan” means prescription drug coverage that is offered—
    • (A) under a policy, contract, or plan that has been approved under section 1395w–111(e) of this title ; and
    • (B) by a PDP sponsor pursuant to, and in accordance with, a contract between the Secretary and the sponsor under section 1395w–112(b) of this title .
  • (15) The term “qualified prescription drug coverage” is defined in section 1395w–102(a)(1) of this title .
  • (16) The term “standard prescription drug coverage” is defined in section 1395w–102(b) of this title .
  • (17) The term “State Pharmaceutical Assistance Program” has the meaning given such term in section 1395w–133(b) of this title .
  • (18) The term “subsidy eligible individual” has the meaning given such term in section 1395w–114(a)(3)(A) of this title .
• (b) For purposes of applying provisions of part C under this part with respect to a prescription drug plan and a PDP sponsor, unless otherwise provided in this part such provisions shall be applied as if—
  • (1) any reference to an MA plan included a reference to a prescription drug plan;
  • (2) any reference to an MA organization or a provider-sponsored organization included a reference to a PDP sponsor;
  • (3) any reference to a contract under section 1395w–27 of this title included a reference to a contract under section 1395w–112(b) of this title ;
  • (4) any reference to part C included a reference to this part; and
  • (5) any reference to an election period under section 1395w–21 of this title were a reference to an enrollment period under section 1395w–101 of this title .