Medigap Coverage of Prescription Drugs or Biologicals Under a Replacement Drug Demonstration Authorized by Section 641(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
This bulletin addresses the situation in which a beneficiary who is covered under any type of Medigap policy participates in a demonstration project authorized by the Secretary of the Department of Health and Human Services (Secretary) under section 641(a) of the MMA that will allow certain self-administered drugs that are not currently covered under Part B to be covered for demonstration participants. The bulletin clarifies that Medigap insurers are not required to cover any cost sharing for replacement drugs and biologicals for which their policyholders are responsible under this demonstration project, which is also referred to as the “replacement drug demonstration.”
Issued by: Centers for Medicare & Medicaid Services (CMS)
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