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Code of Federal Regulations Title 42. Public Health § 42.423.2310 Condition for coverage of drugs under Part D

Current as of January 02, 2025 | Updated by Findlaw Staff

(a) Covered Part D drug coverage requirement. Except as specified in paragraph (b) of this section, in order for coverage to be available under Medicare Part D for applicable drugs of a manufacturer, the manufacturer must do all of the following:

(1) Participate in the Discount Program.

(2) Have entered into and have in effect an agreement described in § 423.2315(b).

(3) Have entered into and have in effect, under terms and conditions specified by CMS, a contract with the TPA.

(b) Exception to covered drug coverage requirement. Paragraph (a) of this section does not apply to an applicable drug if CMS has made a determination that the availability of the applicable drug is essential to the health of beneficiaries enrolled in Medicare Part D.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.423.2310 Condition for coverage of drugs under Part D - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-423-2310/

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