42 U.S.C. § 1395w–103. Access to a choice of qualified prescription drug coverage
- (a)(a)
Assuring access to a choice of coverage
- (1)(a)(1)
Choice of at least two plans in each area
The Secretary shall ensure that each part D eligible individual has available, consistent with paragraph (2), a choice of enrollment in at least 2 qualifying plans (as defined in paragraph (3)) in the area in which the individual resides, at least one of which is a prescription drug plan. In any such case in which such plans are not available, the part D eligible individual shall be given the opportunity to enroll in a fallback prescription drug plan. - (2)(a)(2)
Requirement for different plan sponsors
The requirement in paragraph (1) is not satisfied with respect to an area if only one entity offers all the qualifying plans in the area. - (3)(a)(3)
Qualifying plan defined
For purposes of this section, the term “qualifying plan” means—
- (A)(a)(3)(A)a prescription drug plan; or
- (B)(a)(3)(B)
an MA–PD plan described in section 1395w–21(a)(2)(A)(i) of this title that provides—
- (i)(a)(3)(B)(i)basic prescription drug coverage; or
- (ii)(a)(3)(B)(ii)qualified prescription drug coverage that provides supplemental prescription drug coverage so long as there is no MA monthly supplemental beneficiary premium applied under the plan, due to the application of a credit against such premium of a rebate under section 1395w–24(b)(1)(C) of this title.
- (b)(b)
Flexibility in risk assumed and application of fallback plan
In order to ensure access pursuant to subsection (a) in an area—
- (1)(b)(1)the Secretary may approve limited risk plans under section 1395w–111(f) of this title for the area; and
- (2)(b)(2)only if such access is still not provided in the area after applying paragraph (1), the Secretary shall provide for the offering of a fallback prescription drug plan for that area under section 1395w–111(g) of this title.
(Aug. 14, 1935, ch. 531, title XVIII, § 1860D–3, as added Pub. L. 108–173, title I, § 101(a)(2), Dec. 8, 2003, 117 Stat. 2081.)