42 U.S.C. 1395w-102: Prescription drug benefits

2024

• Pub. L. 118–158 substituted "March 31, 2025" for "December 31, 2024". (American Relief Act, 2025) Law text · (e)

2022

• Pub. L. 117–169, §11201(e)(1)(A), substituted "or, for a year preceding 2025, an increase in the initial" for ", or an increase in the initial". Law text · (a)
• Pub. L. 117–169, §11406(a)(1)(A), substituted "paragraphs (8) and (9)" for "paragraph (8)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(A), substituted "Subject to paragraph (8), the coverage" for "The coverage" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11406(a)(1)(B)(i), substituted "paragraphs (8) and (9)" for "paragraph (8)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(B)(i), inserted "and paragraph (8)" after "and (E)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11202(a)(1)(A), substituted ", (D), and (E)" for "and (D)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(1)(A), inserted "for a year preceding 2025 and for costs above the annual deductible specified in paragraph (1) and up to the annual out-of-pocket threshold specified in paragraph (4)(B) for 2025 and each subsequent year" after "paragraph (3)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11406(a)(1)(B)(ii), substituted ", (8), and (9)" for "and (8)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(B)(ii), substituted "paragraphs (4) and (8)" for "paragraph (4)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(1)(B)(i), inserted "for a year preceding 2025," after "paragraph (4)," in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(1)(B)(ii), substituted "through 2024" for "and each subsequent year". Law text · (b)
• Pub. L. 117–169, §11406(a)(1)(B)(iii), substituted ", (8), and (9)" for "and (8)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(B)(iii), substituted "paragraphs (4) and (8)" for "paragraph (4)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(1)(C)(i)(I), inserted "for a year preceding 2025," after "paragraph (4)," in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(1)(C)(i)(II), substituted "each of years 2019 through 2024" for "a year after 2018". Law text · (b)
• Pub. L. 117–169, §11201(a)(1)(C)(ii), substituted "each of years 2019 through 2024" for "2019 and each subsequent year". Law text · (b)
• Pub. L. 117–169, §11202(a)(1)(B), added subpar. (E). Law text · (b)
• Pub. L. 117–169, §11406(a)(1)(C), substituted "(8), and (9)" for "and (8)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(C), substituted "(4), and (8)" for "and (4)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(2)(A), inserted "for a year preceding 2025," after "and (4)," in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(2)(B), substituted "for each of years 2007 through 2024" for "for a subsequent year". Law text · (b)
• Pub. L. 117–169, §11406(a)(1)(D), substituted "paragraphs (8) and (9)" for "paragraph (8)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(D), substituted "Subject to paragraph (8), the coverage" for "The coverage" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(A)(i), inserted dash after "is equal to" in introductory provisions, designated remainder of existing provisions as subcl. (I), inserted "for a year preceding 2024," before "the greater of—", redesignated former subcls. (I) and (II) as items (aa) and (bb), respectively… Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(A)(ii), substituted "clause (i)(I)(aa) shall be" for "clause (i)(I) shall be" and inserted at end "The Secretary shall continue to calculate the dollar amounts specified in clause (i)(I)(aa), including with the adjustment under this clause, after… Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(B)(i)(I), struck out "or" at end. Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(B)(i)(II), substituted "for each of years 2021 through 2024" for "for a subsequent year" and semicolon for period at end. Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(B)(i)(III), added subcls. (VII) and (VIII). Law text · (b), (VIII)
• Pub. L. 117–169, §11201(a)(3)(B)(ii), substituted "clause (i)" for "clause (i)(II)". Law text · (b)
• Pub. L. 117–169, §11202(a)(2)(A), substituted "subparagraph (E) or subparagraph (F)" for "subparagraph (E)" in introductory provisions. Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(C)(i), substituted "and, for a year preceding 2025, for amounts" for "and for amounts". Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(C)(ii), inserted dash after "if such costs" in introductory provisions, designated remainder of existing provisions as subcl. (I), redesignated former subcls. (I) to (IV) as items (aa) to (dd), respectively, of subcl. (I) and realigned margins, … Law text · (b)
• Pub. L. 117–169, §11401(c)(2), added item (dd) referring to section 1395w–115(h) of this title. Law text · (b)
• Pub. L. 117–169, §11201(a)(3)(D), substituted "For each of years 2011 through 2024, in applying" for "In applying". Law text · (b)
• Pub. L. 117–169, §11202(a)(2)(B), added subpar. (F). Law text · (b)
• Pub. L. 117–169, §11401(a)(1)(E), added par. (8). Law text · (b)
• Pub. L. 117–169, §11406(a)(1)(E), added par. (9). Law text · (b)
• Pub. L. 117–169, §11201(e)(1)(B), struck out "at initial coverage limit" after "payment for costs" in heading and inserted "for a year preceding 2025 or the annual out-of-pocket threshold specified in subsection (b)(4)(B) for the year for 2025 and each subsequent year" after "sub… Law text · (c)
• Pub. L. 117–169, §11202(b), added par. (4). Law text · (c)
• Pub. L. 117–169, §11401(a)(2), added par. (5). Law text · (c)
• Pub. L. 117–169, §11406(a)(2), added par. (6). Law text · (c)
• Pub. L. 117–169, §11201(e)(1)(C), substituted "or, for a year preceding 2025, an initial" for "or an initial". Law text · (d)
• Pub. L. 117–169, §11001(b)(1)(D)(i), inserted ", subject to subparagraph (D)," after "negotiated prices". Law text · (d)
• Pub. L. 117–169, §11001(b)(1)(D)(ii), added subpar. (D). Law text · (d)
• Pub. L. 117–328 added subpar. (C). (Consolidated Appropriations Act, 2023) Law text · (e)

2018

• Pub. L. 115–123, §53116(a)(1), amended subcl. (I) generally. Prior to amendment, subcl. (I) read as follows: "equal to the difference between the applicable gap percentage (specified in clause (ii) for the year) and the discount percentage specified in section 1395w–114a(g)… (Bipartisan Budget Act of 2018) Law text · (b)
• Pub. L. 115–123, §53116(a)(2), substituted "2019" for "2020" in subcl. (VI), redesignated subcl. (VI) as (V), and struck out former subcl. (V) which read as follows: "2019 is 80 percent; and". (Bipartisan Budget Act of 2018) Law text · (b), (VI)

2010

• Pub. L. 111–152, §1101(b)(3)(A), substituted "Subject to subparagraphs (C) and (D), the coverage" for "The coverage". (Health Care and Education Reconciliation Act of 2010) Law text · (b)
• Pub. L. 111–152, §1101(b)(3)(B), substituted "subparagraphs (A)(ii), (C), and (D)" for "subparagraph (A)(ii)". (Health Care and Education Reconciliation Act of 2010) Law text · (b)
• Pub. L. 111–152, §1101(b)(3)(C), added subpars. (C) and (D). (Health Care and Education Reconciliation Act of 2010) Law text · (b), (D)
• Pub. L. 111–152, §1101(b)(3)(D), substituted "paragraphs (2)(C), (2)(D), and (4)" for "paragraph (4)". (Health Care and Education Reconciliation Act of 2010) Law text · (b)
• Pub. L. 111–148, §3315(1), which directed substitution of "paragraphs (4) and (7)" for "paragraph (4)" in introductory provisions, was repealed by Pub. L. 111–152, §1101(a)(2). See Construction of 2010 Amendment note below. (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–152, §1101(d)(1), added subcls. (II) to (V) and redesignated former subcl. (II) as (VI). (Health Care and Education Reconciliation Act of 2010) Law text · (b)
• Pub. L. 111–148, §3314(a), in cl. (ii), substituted "subject to clause (iii), such costs shall be treated as incurred only if" for "such costs shall be treated as incurred only if" and struck out ", under section 1395w–114 of this title, or under a State Pharmaceutical Assistance… (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–148, §3301(c)(1)(A), substituted "Except as provided in subparagraph (E), in applying" for "In applying" in introductory provisions. (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–152, §1101(b)(3)(E), inserted before period at end ", except that incurred costs shall not include the portion of the negotiated price that represents the reduction in coinsurance resulting from the application of paragraph (2)(D)". (Health Care and Education Reconciliation Act of 2010) Law text · (b)
• Pub. L. 111–148, §3301(c)(1)(B), added subpar. (E). (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–152, §1101(d)(2), added par. (7). (Health Care and Education Reconciliation Act of 2010) Law text · (b)
• Pub. L. 111–148, §3315(2), which directed addition of par. (7), was repealed by Pub. L. 111–152, §1101(a)(2). As enacted, text read as follows: (Patient Protection and Affordable Care Act) Law text · (b)

2008

• Pub. L. 110–275, §182(a)(1)(A), substituted "(as defined in paragraph (4))" for "(as defined in section 1396r–8(k)(6) of this title)" in concluding provisions. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §175(a), inserted "other than subparagraph (I) of such section (relating to barbiturates) if the barbiturate is used in the treatment of epilepsy, cancer, or a chronic mental health disorder, and other than subparagraph (J) of such section (relating to benzodiaze… (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §182(a)(1)(B), which directed amendment of subsec. (e)(1) in the matter following subpar. (B) by adding par. (4) at the end, was executed by adding par. (4) at end of subsec. (e), to reflect the probable intent of Congress. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)

2006

• Pub. L. 109–432 inserted "(and, for vaccines administered on or after January 1, 2008, its administration)" after "section 262 of this title" in concluding provisions. (Tax Relief and Health Care Act of 2006) Law text · (e)

2005

• Pub. L. 109–91, §103(a)(2), inserted at end "Such term also does not include a drug when used for the treatment of sexual or erectile dysfunction, unless such drug were used to treat a condition, other than sexual or erectile dysfunction, for which the drug has been approved by t… (QI, TMA, and Abstinence Programs Extension and Hurricane Katrina Unemployment Relief Act of 2005) Law text · (e)
• Pub. L. 109–91, §103(a)(1), inserted before period at end ", as such sections were in effect on December 8, 2003". (QI, TMA, and Abstinence Programs Extension and Hurricane Katrina Unemployment Relief Act of 2005) Law text · (e)