Page:United States Statutes at Large Volume 102 Part 1.djvu/744

 102 STAT. 706

PUBLIC LAW 100-360—JULY 1, 1988 "(O COINSURANCE PERCENT.—For purposes of subparagraph (B), the coinsurance percent— "(i) for covered home IV drugs and for drugs described in paragraph dXAXiii) (relating to immunosuppressive therapy during the 1st year after transplant), is 20 percent; and "(ii) for other covered outpatient drugs dispensed— "(X) in 1990 or 1991, is 50 percent, "(ID in 1992 is 40 percent, and "(HI) in 1993 or a succeeding year is 20 percent.

Contracts.

"(D)

TREATMENT

OP

CERTAIN

COST-BASED

PREPAID

ORGANIZATIONS.—In applying subparagraph (A) in the case of an organization under a reasonable cost reimbursement contract under section 1876 and in the case of an organization receiving payment under section 1833(a)(l)(A) and providing coverage of covered outpatient drugs, the Secretary shall provide for an appropriate adjustment in the payment amounts otherwise made to reflect the aggr^ate increase in payments that would otherwise be made Mdth respect to enrollees in such an organization if payments were made other than under such clause or such a contract on an individual-by-individual basis. "(A) PAYMENT LIMIT FOR NON-MULTIPLE SOURCE DRUGS AND MULTIPLEH30URCE DRUGS WITH RESTRICTIVE PRESCRIPTIONS.—
 * (3) PAYMENT LIMITS.—

In the case of a drug that either is not a multiple source drug (as defined in paragraph (9)(A)) or is a multiple source drug and has a restrictive prescription (as defined in paragraph (9)(B)), the payment limit for the drug under this paragraph for a payment calculation period is equal to the lesser of— "(i) the 90th percentile of the actual charges (computed on a statewide basis, carrier-wide basis, or other appropriate geographic area basis, as specified by the Secretary) for the drug for the second previous payment c£dculation period, adjusted (as the Secretary determines to be appropriate) to reflect the number of tablets (or other dosage units) dispensed; or "(ii) the amount of the administrative allowance (established under paragraph (4)) plus the product of— "(I) the number of t£d)lets (or other dosage units) dispensed, and (n) the per tablet or unit average wholesale price for such drug (as determined under subparagraph (C) for the period for purposes of this subparagraph); except that clause (i) shall not apply to covered outpatient drugs dispensed before January 1, 1992. "©) PAYMENT UMTT FOR MULTIPLE SOURCE DRUGS WITHOUT

RESTRICTIVE PRESCRIPTIONS.—In the case of a drug that is a multiple source drug but does not have a restrictive prescription, the payment limit for the drug under this paragraph for a payment calculation period is equal to the amount of the administrative allowance (established under paragraph (4)) plus the product of— "(i) the number of tablets (or other dosage units) dispensed, and

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