Code of Federal Regulations Title 42. Public Health § 42.513.200 Payment process and beneficiary cost-sharing

(a) General. For purposes of the MFN Model, the allowed MFN Drug Payment Amount does not exceed the billed amount on the claim for the MFN Model drug.

(b) Model-specific billing instructions. MFN participants submit claims for MFN Model drugs to the applicable MAC in the form and manner specified by CMS in model-specific billing instructions.

(c) Beneficiary cost-sharing. Beneficiary coinsurance does not apply to the portion of the allowed payment amount for an MFN Model drug that is determined under § 513.220.