42 U.S.C. § 1395w–134 — Coordination requirements for plans providing prescription drug coverage

(a) Applying benefit-coordination requirements to additional plans.

(1) The Secretary^* must apply the coordination requirements established under section 1395w–133(a) to the Rx plans in subsection (b) in the same way they apply to a State Pharmaceutical Assistance Program^*.

(2) To the extent the Secretary specifies, those requirements also apply to procedures under section 1395w–102(b)(4)(D) for treating certain out-of-pocket expenses.

(3) User fees.

(A) The Secretary may charge user fees for sending information needed for coordination under section 1395w–102(b)(4)(D), in a way similar to fees under section 1395u(h)(3)(B). The Secretary may keep part of the fees to pay the costs of carrying out those procedures.

(B) The Secretary may not charge that fee to a State^* Pharmaceutical Assistance Program.

(b) Rx plan. An Rx plan is—

(1) a state Medicaid plan under subchapter XIX, including one operating under a section 1315 waiver, if it meets section 1395w–133(b)(2);

(2) an employer group health plan^*;

(3) the federal employees’ health benefits plan under title 5, chapter 89;

(4) coverage under title 10, chapter 55, including TRICARE; or

(5) another health-benefit plan or program the Secretary specifies that provides prescription drug^* coverage or financial help to buy or provide it for eligible individuals.

(c) Relation to other provisions.

(1) These requirements do not impair or prevent a PDP sponsor^* or MA organization from using cost-management tools, including different payments, under any method of operation.

(2) These requirements do not affect how the procedures under section 1395w–102(b)(4)(D) apply to certain out-of-pocket expenses.