42 C.F.R. § 423.2410

Current through November 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.

42 C.F.R. §423.2410

78 FR 31310 , May 23, 2013; 78 FR 43821 , July 22, 2013; 83 FR 16756 , Apr. 16, 2018
83 FR 16756 , 6/15/2018