As used in this subpart, unless specified otherwise-
Actual costs means the subset of prescription drug costs (not including administrative costs or return on investment, but including costs directly related to the dispensing of covered Part D drugs during the year) that are attributable to standard benefits only and that are incurred and actually paid by the sponsor or organization under the plan.
Actually paid has the same meaning described in § 423.308 .
Eligible fallback entity or fallback entity means an entity that, for a particular contract period-
Fallback prescription drug plan means a prescription drug plan (PDP) offered by a fallback entity that-
Qualifying plan means a full-risk or limited-risk prescription drug plan, as defined in § 423.258 , or an MA-PD plan described in section 1851(a)(2)(A)(i) of the Act, that provides required prescription drug coverage, as defined in § 423.100 An MA-PD plan must be open for enrollment and not operating under a capacity waiver to be counted as a qualifying plan. A PDP must not be operating under a restricted enrollment waiver, such as those that may be granted to special needs plans or employer group plans, in order to be counted as a qualifying plan in an area.
42 C.F.R. §423.855