PUBLIC LAW 108–173—DEC. 8, 2003
117 STAT. 2077
‘‘(1) DEDUCTIBLE.— ‘‘(A) IN GENERAL.—The coverage has an annual deductible— ‘‘(i) for 2006, that is equal to $250; or ‘‘(ii) for a subsequent year, that is equal to the amount specified under this paragraph for the previous year increased by the percentage specified in paragraph (6) for the year involved. ‘‘(B) ROUNDING.—Any amount determined under subparagraph (A)(ii) that is not a multiple of $5 shall be rounded to the nearest multiple of $5. ‘‘(2) BENEFIT STRUCTURE.— ‘‘(A) 25 PERCENT COINSURANCE.—The coverage has coinsurance (for costs above the annual deductible specified in paragraph (1) and up to the initial coverage limit under paragraph (3)) that is— ‘‘(i) equal to 25 percent; or ‘‘(ii) actuarially equivalent (using processes and methods established under section 1860D–11(c)) to an average expected payment of 25 percent of such costs. ‘‘(B) USE OF TIERS.—Nothing in this part shall be construed as preventing a PDP sponsor or an MA organization from applying tiered copayments under a plan, so long as such tiered copayments are consistent with subparagraph (A)(ii). ‘‘(3) INITIAL COVERAGE LIMIT.— ‘‘(A) IN GENERAL.—Except as provided in paragraph (4), the coverage has an initial coverage limit on the maximum costs that may be recognized for payment purposes (including the annual deductible)— ‘‘(i) for 2006, that is equal to $2,250; or ‘‘(ii) for a subsequent year, that is equal to the amount specified in this paragraph for the previous year, increased by the annual percentage increase described in paragraph (6) for the year involved. ‘‘(B) ROUNDING.—Any amount determined under subparagraph (A)(ii) that is not a multiple of $10 shall be rounded to the nearest multiple of $10. ‘‘(4) PROTECTION AGAINST HIGH OUT-OF-POCKET EXPENDITURES.— ‘‘(A) IN GENERAL.— ‘‘(i) IN GENERAL.—The coverage provides benefits, after the part D eligible individual has incurred costs (as described in subparagraph (C)) for covered part D drugs in a year equal to the annual out-of-pocket threshold specified in subparagraph (B), with costsharing that is equal to the greater of— ‘‘(I) a copayment of $2 for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)) and $5 for any other drug; or ‘‘(II) coinsurance that is equal to 5 percent. ‘‘(ii) ADJUSTMENT OF AMOUNT.—For a year after 2006, the dollar amounts specified in clause (i)(I) shall be equal to the dollar amounts specified in this subparagraph for the previous year, increased by the annual percentage increase described in paragraph (6)
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