Current through September 30, 2024
Section 423.2410 - General requirements(a) For contracts beginning in 2014 or subsequent contract years, a Part D sponsor (defined at § 423.4 ) is required to report the information required under § 423.2460 for each contract under this part for each contract year.(b) If CMS determines for a contract year that a Part D sponsor has an MLR for a contract that is less than 0.85, the Part D sponsor must remit to CMS an amount equal to the product of the following:(1) The total revenue of the prescription drug plan for the contract year.(2) The difference between 0.85 and the MLR for the contract year.(c) If CMS determines that a Part D sponsor has an MLR for a contract that is less than 0.85 for 3 or more consecutive contract years, CMS does not permit the enrollment of new enrollees under the contract for coverage during the second succeeding contract year.(d) If CMS determines that a Part D sponsor has an MLR for a contract that is less than 0.85 for 5 consecutive contract years, CMS terminates the contract under the authority at 423.509(b)(1) and (d) effective as of the second succeeding contract year.78 FR 31310, May 23, 2013; 78 FR 43821, July 22, 2013; 83 FR 16756, Apr. 16, 2018