---
kind: "section"
citation: "42 U.S.C. § 1395w–103"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395w–103"
heading: "Access to a choice of qualified prescription drug coverage"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395w-103"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part D — Voluntary Prescription Drug Benefit Program"
  - "Subpart 1 — part d eligible individuals and prescription drug benefits"
---

# §1395w–103. Access to a choice of qualified prescription drug coverage

- (a) **Assuring access to a choice of coverage—**
  - (1) **Choice of at least two plans in each area—** The [Secretary](/usc/42/1301.md?p=a-6) shall ensure that each [part D eligible individual](/usc/42/1395w–151.md?p=a-4) has available, consistent with [paragraph (2)](#a-2), a choice of enrollment in at least 2 qualifying plans (as defined in [paragraph (3)](#a-3)) in the area in which the individual resides, at least one of which is a [prescription drug plan](/usc/42/1395w–151.md?p=a-14). In any such case in which such plans are not available, the [part D eligible individual](/usc/42/1395w–151.md?p=a-4) shall be given the opportunity to enroll in a [fallback prescription drug plan](/usc/42/1395w–151.md?p=a-5).
  - (2) **Requirement for different plan sponsors—** The requirement in [paragraph (1)](#a-1) is not satisfied with respect to an area if only one entity offers all the qualifying plans in the area.
  - (3) **Qualifying plan defined—** For purposes of this section, the term “qualifying plan” means—
    - (A) a [prescription drug plan](/usc/42/1395w–151.md?p=a-14); or
    - (B) an [MA–PD plan](/usc/42/1395w–151.md?p=a-9) described in [section 1395w–21(a)(2)(A)(i) of this title](/usc/42/1395w–21.md?p=a-2-A-i) that provides—
      - (i) [basic prescription drug coverage](/usc/42/1395w–151.md?p=a-1); or
      - (ii) [qualified prescription drug coverage](/usc/42/1395w–151.md?p=a-15) that provides supplemental prescription [drug](/usc/42/11851.md?p=4) coverage so long as there is no MA monthly supplemental beneficiary premium applied under the plan, due to the application of a credit against such premium of a rebate under [section 1395w–24(b)(1)(C) of this title](/usc/42/1395w–24.md?p=b-1-C).
- (b) **Flexibility in risk assumed and application of fallback plan—** In order to ensure access pursuant to [subsection (a)](#a) in an area—
  - (1) the [Secretary](/usc/42/1301.md?p=a-6) may approve limited risk plans under [section 1395w–111(f) of this title](/usc/42/1395w–111.md?p=f) for the area; and
  - (2) only if such access is still not provided in the area after applying [paragraph (1)](#b-1), the [Secretary](/usc/42/1301.md?p=a-6) shall provide for the offering of a [fallback prescription drug plan](/usc/42/1395w–151.md?p=a-5) for that area under [section 1395w–111(g) of this title](/usc/42/1395w–111.md?p=g).

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1860D–3, as added Pub. L. 108–173, title I, § 101(a)(2), Dec. 8, 2003, 117 Stat. 2081.)