Summary
Requires inclusion of drug costs incurred by AIDS drug assistance programs and Indian Health Service on behalf of Part D enrollees toward their annual out-of-pocket cap.
Implementation Status
In the April 15, 2011, final rule governing MA and Part D policy, CMS finalized implementation of this provision (see pp. 21474-75).
Statutory Text
SEC. 3314. INCLUDING COSTS INCURRED BY AIDS DRUG ASSISTANCE PROGRAMS AND INDIAN HEALTH SERVICE IN PROVIDING PRESCRIPTION DRUGS TOWARD THE ANNUAL OUT-OFPOCKET THRESHOLD UNDER PART D. (a) IN GENERAL.—Section 1860D–2(b)(4)(C) of the Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is amended— (1) in clause (i), by striking ‘‘and’’ at the end; (2) in clause (ii)— (A) by striking ‘‘such costs shall be treated as incurred only if’’ and inserting ‘‘subject to clause (iii), such costs shall be treated as incurred only if’’; (B) by striking ‘‘, under section 1860D–14, or under a State Pharmaceutical Assistance Program’’; and (C) by striking the period at the end and inserting ‘‘; and’’; and (3) by inserting after clause (ii) the following new clause: ‘‘(iii) such costs shall be treated as incurred and shall not be considered to be reimbursed under clause (ii) if such costs are borne or paid— ‘‘(I) under section 1860D–14; ‘‘(II) under a State Pharmaceutical Assistance Program; ‘‘(III) by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act); or ‘‘(IV) under an AIDS Drug Assistance Program under part B of title XXVI of the Public Health Service Act.’’. (b) EFFECTIVE DATE.—The amendments made by subsection (a) shall apply to costs incurred on or after January 1, 2011.