117 STAT. 2082
PUBLIC LAW 108–173—DEC. 8, 2003
of a credit against such premium of a rebate under section 1854(b)(1)(C). ‘‘(b) FLEXIBILITY IN RISK ASSUMED AND APPLICATION OF FALLBACK PLAN.—In order to ensure access pursuant to subsection (a) in an area— ‘‘(1) the Secretary may approve limited risk plans under section 1860D–11(f) for the area; and ‘‘(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 1860D–11(g). ‘‘BENEFICIARY
‘‘SEC. 1860D–4. (a) DISSEMINATION OF INFORMATION.— ‘‘(1) GENERAL INFORMATION.— ‘‘(A) APPLICATION OF MA INFORMATION.—A PDP sponsor shall disclose, in a clear, accurate, and standardized form to each enrollee with a prescription drug plan offered by the sponsor under this part at the time of enrollment and at least annually thereafter, the information described in section 1852(c)(1) relating to such plan, insofar as the Secretary determines appropriate with respect to benefits provided under this part, and including the information described in subparagraph (B). ‘‘(B) DRUG SPECIFIC INFORMATION.—The information described in this subparagraph is information concerning the following: ‘‘(i) Access to specific covered part D drugs, including access through pharmacy networks. ‘‘(ii) How any formulary (including any tiered formulary structure) used by the sponsor functions, including a description of how a part D eligible individual may obtain information on the formulary consistent with paragraph (3). ‘‘(iii) Beneficiary cost-sharing requirements and how a part D eligible individual may obtain information on such requirements, including tiered or other copayment level applicable to each drug (or class of drugs), consistent with paragraph (3). ‘‘(iv) The medication therapy management program required under subsection (c). ‘‘(2) DISCLOSURE UPON REQUEST OF GENERAL COVERAGE, UTILIZATION, AND GRIEVANCE INFORMATION.—Upon request of a part D eligible individual who is eligible to enroll in a prescription drug plan, the PDP sponsor offering such plan shall provide information similar (as determined by the Secretary) to the information described in subparagraphs (A), (B), and (C) of section 1852(c)(2) to such individual. ‘‘(3) PROVISION OF SPECIFIC INFORMATION.— ‘‘(A) RESPONSE TO BENEFICIARY QUESTIONS.—Each PDP sponsor offering a prescription drug plan shall have a mechanism for providing specific information on a timely basis to enrollees upon request. Such mechanism shall include access to information through the use of a tollfree telephone number and, upon request, the provision of such information in writing.
42 USC 1395w–104.
VerDate 11-MAY-2000
13:59 Aug 30, 2004
PROTECTIONS FOR QUALIFIED PRESCRIPTION DRUG COVERAGE
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