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

(a) Definitions. For this part: (1) “Basic prescription drug coverage^*” is defined in section 1395w–102(a)(3); this section does not define it. (2) “Covered part D drug^*” is defined in section 1395w–102(e); this section does not define it. (3) “Creditable prescription drug^* coverage” has the meaning in section 1395w–113(b)(4); this section does not define it. (4) “Part D eligible individual” has the meaning in section 1395w–101(a)(3)(A); this section does not define it. (5) “Fallback prescription drug plan” has the meaning in section 1395w–111(g)(4); this section does not define it. (6) “Initial coverage limit” means the limit set under section 1395w–102(b)(3) for a year before 2025. For coverage that is not standard prescription-drug coverage, it means the comparable limit, if any, set under that coverage for that year. (7) “Insurance risk,” for a participating pharmacy, means risk of the kind commonly assumed only by State^*-licensed insurers. It does not include payment changes designed to reflect performance measures within the pharmacy’s control, such as following a formulary or substituting generic drugs. (8) “MA plan” has the meaning in section 1395w–101(a)(3)(B); this section does not define it. (9) “MA–PD plan” has the meaning in section 1395w–101(a)(3)(C); this section does not define it. (10) “Medicare Prescription Drug Account” means the Account created under section 1395w–116(a). (11) “PDP approved bid” has the meaning in section 1395w–113(a)(6); this section does not define it. (12) “PDP region” means a region provided under section 1395w–111(a)(2); this section does not define it. (13) “PDP sponsor” means a nongovernmental entity certified under this part as meeting this part’s requirements and standards for such a sponsor. (14) “Prescription drug plan” means prescription-drug coverage offered (A) under a policy, contract, or plan approved under section 1395w–111(e), and (B) by a PDP sponsor under a contract between the Secretary^* and sponsor under section 1395w–112(b). (15) “Qualified prescription drug coverage^*” is defined in section 1395w–102(a)(1); this section does not define it. (16) “Standard prescription drug coverage^*” is defined in section 1395w–102(b); this section does not define it. (17) “State Pharmaceutical Assistance Program” has the meaning in section 1395w–133(b); this section does not define it. (18) “Subsidy eligible individual” has the meaning in section 1395w–114(a)(3)(A); this section does not define it.
(b) Applying Part C provisions under Part D. When Part C provisions are applied under this part to a prescription-drug plan or PDP sponsor, and this part does not say otherwise, apply them as if: (1) a reference to an MA plan included a prescription-drug plan; (2) a reference to an MA organization or provider-sponsored organization included a PDP sponsor; (3) a reference to a contract under section 1395w–27 included a contract under section 1395w–112(b); (4) a reference to Part C included a reference to this part; and (5) a reference to an election period under section 1395w–21 meant an enrollment period under section 1395w–101.