---
kind: "section"
citation: "42 U.S.C. § 1395w–134"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395w–134"
heading: "Coordination requirements for plans providing prescription drug coverage"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395w-134"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part D — Voluntary Prescription Drug Benefit Program"
  - "Subpart 3 — application to medicare advantage program and treatment of employer-sponsored programs and other prescription drug plans"
---

# §1395w–134. Coordination requirements for plans providing prescription drug coverage

- (a) **Application of benefit coordination requirements to additional plans—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall apply the coordination requirements established under [section 1395w–133(a) of this title](/usc/42/1395w–133.md?p=a) to Rx plans described in [subsection (b)](#b) in the same manner as such requirements apply to a [State Pharmaceutical Assistance Program](/usc/42/1395w–151.md?p=a-17).
  - (2) **Application to treatment of certain out-of-pocket expenditures—** To the extent specified by the [Secretary](/usc/42/1301.md?p=a-6), the requirements referred to in [paragraph (1)](#a-1) shall apply to procedures established under [section 1395w–102(b)(4)(D) of this title](/usc/42/1395w–102.md?p=b-4-D).
  - (3) **User fees—**
    - (A) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) may impose user fees for the transmittal of information necessary for benefit coordination under [section 1395w–102(b)(4)(D) of this title](/usc/42/1395w–102.md?p=b-4-D) in a manner similar to the manner in which user fees are imposed under [section 1395u(h)(3)(B) of this title](/usc/42/1395u.md?p=h-3-B), except that the [Secretary](/usc/42/1301.md?p=a-6) may retain a portion of such fees to defray the [Secretary](/usc/42/1301.md?p=a-6)’s costs in carrying out procedures under [section 1395w–102(b)(4)(D) of this title](/usc/42/1395w–102.md?p=b-4-D).
    - (B) **Application—** A user fee may not be imposed under [subparagraph (A)](#a-3-A) with respect to a [State Pharmaceutical Assistance Program](/usc/42/1395w–151.md?p=a-17).
- (b) **Rx Plan—** An Rx plan described in this subsection is any of the following:
  - (1) **Medicaid programs—** A [State](/usc/42/619.md?p=5) plan under subchapter XIX, [including](/usc/42/1301.md?p=b) such a plan operating under a waiver under [section 1315 of this title](/usc/42/1315.md), if it meets the requirements of [section 1395w–133(b)(2) of this title](/usc/42/1395w–133.md?p=b-2).
  - (2) **Group health plans—** An employer [group health plan](/usc/42/1397jj.md?p=c-3).
  - (3) **FEHBP—** The Federal employees health benefits plan under chapter 89 of title 5.
  - (4) **Military coverage (including TRICARE)—** Coverage under chapter 55 of title 10.
  - (5) **Other prescription drug coverage—** Such other health benefit plans or programs that provide coverage or financial assistance for the purchase or provision of prescription [drug](/usc/42/11851.md?p=4) coverage on behalf of [part D eligible individuals](/usc/42/1395w–151.md?p=a-4) as the [Secretary](/usc/42/1301.md?p=a-6) may specify.
- (c) **Relation to other provisions—**
  - (1) **Use of cost management tools—** The requirements of this section shall not impair or prevent a [PDP sponsor](/usc/42/1395w–151.md?p=a-13) or MA organization from applying cost management tools ([including](/usc/42/1301.md?p=b) differential payments) under all methods of operation.
  - (2) **No affect 1 on treatment of certain out-of-pocket expenditures—** The requirements of this section shall not affect the application of the procedures established under [section 1395w–102(b)(4)(D) of this title](/usc/42/1395w–102.md?p=b-4-D).

## Footnotes

[^1]: So in original. Probably should be “effect”.

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1860D–24, as added Pub. L. 108–173, title I, § 101(a)(2), Dec. 8, 2003, 117 Stat. 2130.)