PUBLIC LAW 108–173—DEC. 8, 2003
117 STAT. 2083
‘‘(B) AVAILABILITY OF INFORMATION ON CHANGES IN FORMULARY THROUGH THE INTERNET.—A PDP sponsor offering a prescription drug plan shall make available on a timely basis through an Internet website information on specific changes in the formulary under the plan (including changes to tiered or preferred status of covered part D drugs). ‘‘(4) CLAIMS INFORMATION.—A PDP sponsor offering a prescription drug plan must furnish to each enrollee in a form easily understandable to such enrollees— ‘‘(A) an explanation of benefits (in accordance with section 1806(a) or in a comparable manner); and ‘‘(B) when prescription drug benefits are provided under this part, a notice of the benefits in relation to— ‘‘(i) the initial coverage limit for the current year; and ‘‘(ii) the annual out-of-pocket threshold for the current year. Notices under subparagraph (B) need not be provided more often than as specified by the Secretary and notices under subparagraph (B)(ii) shall take into account the application of section 1860D–2(b)(4)(C) to the extent practicable, as specified by the Secretary. ‘‘(b) ACCESS TO COVERED PART D DRUGS.— ‘‘(1) ASSURING PHARMACY ACCESS.— ‘‘(A) PARTICIPATION OF ANY WILLING PHARMACY.—A prescription drug plan shall permit the participation of any pharmacy that meets the terms and conditions under the plan. ‘‘(B) DISCOUNTS ALLOWED FOR NETWORK PHARMACIES.— For covered part D drugs dispensed through in-network pharmacies, a prescription drug plan may, notwithstanding subparagraph (A), reduce coinsurance or copayments for part D eligible individuals enrolled in the plan below the level otherwise required. In no case shall such a reduction result in an increase in payments made by the Secretary under section 1860D–15 to a plan. ‘‘(C) CONVENIENT ACCESS FOR NETWORK PHARMACIES.— ‘‘(i) IN GENERAL.—The PDP sponsor of the prescription drug plan shall secure the participation in its network of a sufficient number of pharmacies that dispense (other than by mail order) drugs directly to patients to ensure convenient access (consistent with rules established by the Secretary). ‘‘(ii) APPLICATION OF TRICARE STANDARDS.—The Secretary shall establish rules for convenient access to in-network pharmacies under this subparagraph that are no less favorable to enrollees than the rules for convenient access to pharmacies included in the statement of work of solicitation (#MDA906–03–R– 0002) of the Department of Defense under the TRICARE Retail Pharmacy (TRRx) as of March 13, 2003. ‘‘(iii) ADEQUATE EMERGENCY ACCESS.—Such rules shall include adequate emergency access for enrollees. ‘‘(iv) CONVENIENT ACCESS IN LONG-TERM CARE FACILITIES.—Such rules may include standards with respect to access for enrollees who are residing in
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