PUBLIC LAW 108–173—DEC. 8, 2003
117 STAT. 2247
program in an area and which are prescribed by a physician who has elected this section to apply— ‘‘(i) the claim for such drugs and biologicals shall be submitted by the contractor that supplied the drugs and biologicals; ‘‘(ii) collection of amounts of any deductible and coinsurance applicable with respect to such drugs and biologicals shall be the responsibility of such contractor and shall not be collected unless the drug or biological is administered to the individual involved; and ‘‘(iii) the payment under this section (and related amounts of any applicable deductible and coinsurance) for such drugs and biologicals— ‘‘(I) shall be made only to such contractor; and ‘‘(II) shall be conditioned upon the administration of such drugs and biologicals. ‘‘(B) PROCESS FOR ADJUSTMENTS.—The Secretary shall provide a process for adjustments to payments in the case in which payment is made for drugs and biologicals which were billed at the time of dispensing but which were not actually administered. ‘‘(C) INFORMATION FOR PURPOSES OF COST-SHARING.— The Secretary shall provide a process by which physicians submit information to contractors for purposes of the collection of any applicable deductible or coinsurance amounts under subparagraph (A)(ii). ‘‘(4) CONTRACT REQUIRED.—Payment may not be made under this part for competitively biddable drugs and biologicals prescribed by a physician who has elected this section to apply within a category and a competitive acquisition area with respect to which the program applies unless— ‘‘(A) the drugs or biologicals are supplied by a contractor with a contract under this section for such category of drugs and biologicals and area; and ‘‘(B) the physician has elected such contractor under paragraph (5) for such category and area. ‘‘(5) CONTRACTOR SELECTION PROCESS.— ‘‘(A) ANNUAL SELECTION.— ‘‘(i) IN GENERAL.—The Secretary shall provide a process for the selection of a contractor, on an annual basis and in such exigent circumstances as the Secretary may provide and with respect to each category of competitively biddable drugs and biologicals for an area by selecting physicians. ‘‘(ii) TIMING OF SELECTION.—The selection of a contractor under clause (i) shall be made at the time of the election described in section 1847A(a) for this section to apply and shall be coordinated with agreements entered into under section 1842(h). ‘‘(B) INFORMATION ON CONTRACTORS.—The Secretary shall make available to physicians on an ongoing basis, through a directory posted on the Internet website of the Centers for Medicare & Medicaid Services or otherwise and upon request, a list of the contractors under this section in the different competitive acquisition areas.
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