42 C.F.R. § 423.132 Public disclosure of pharmaceutical prices for equivalent drugs.
Title 42 - Public Health
(a) General requirements. Except as provided under paragraph (c) of this section, a Part D sponsor must require a pharmacy that dispenses a covered Part D drug to inform an enrollee of any differential between the price of that drug and the price of the lowest priced generic version of that covered Part D drug that is therapeutically equivalent and bioequivalent and available at that pharmacy, unless the particular covered Part D drug being purchased is the lowest-priced therapeutically equivalent and bioequivalent version of that drug available at that pharmacy. (b) Timing of notice. Subject to paragraph (d) of this section, the information under paragraph (a) of this section must be provided after the drug is dispensed at the point of sale or, in the case of dispensing by mail order, at the time of delivery of the drug. (c) Waiver of public disclosure requirement. CMS waives the requirement under paragraph (a) of this section in the case of— (1) An MA private fee-for-service plan described in §422.4 of this chapter that— (i) Offers qualified prescription drug coverage and provides plan enrollees with access to covered Part D drugs dispensed at all pharmacies, without regard to whether they are contracted network pharmacies; and (ii) Does not charge additional cost-sharing for access to covered Part D drugs dispensed at out-of-network pharmacies. (2) An out-of-network pharmacy; (3) An I/T/U network pharmacy; (4) A network pharmacy that is located in any of the U.S. territories; and (5) Other circumstances where CMS deems compliance with the requirements of paragraph (a) of this section to be impossible or impracticable. (d) Modification of timing requirement. CMS modifies the requirement under paragraph (b) of this section as follows— (1) For long-term care network pharmacies, which must meet the requirement in paragraph (a) of this section by providing such information to Part D plans for inclusion in the written explanations of benefits required under §423.128(e); and (2) Under other circumstances where CMS deems compliance with the requirement under paragraph (b) of this section to be impossible or impracticable.
Title 42: Public Health
PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
Subpart C—Benefits and Beneficiary Protections
§ 423.132 Public disclosure of pharmaceutical prices for equivalent drugs.
