42 CFR § 403.817 - Special rules concerning the territories.
(a) In general.
(b) Requirements -
(1) Negotiated prices. A special endorsed sponsor for residents of the territories must provide access to negotiated prices in the territories.
(c) Waiver of requirements and alternative requirements.
(2) Sections 403.806(f)(2) and (f)(3) will be deemed met if the special endorsed sponsor makes a good faith effort to secure the participation of retail and mail order pharmacies throughout a territory.
(i) As the Secretary determines appropriate on a case-by-case basis, any additional requirements discussed in §§ 403.804 and 403.806, except for the requirements in §§ 403.812 and 403.813, may be waived or modified on behalf of a special endorsed sponsor for the territories if -
(A) Such waiver is necessary to enable the applicant to either initiate enrollment activities under the special endorsement within 6 months of enactment of section 1860D-31 of the Act, or accommodate the unique needs of pharmacies in the territories; or
(B) Compliance with the requirement(s) in question would be impracticable or inefficient.
(d) Other exceptions. A special endorsed sponsor for the territories may enroll in its endorsed discount card program Medicaid enrollees with coverage for outpatient prescription drugs, as described in § 403.810(a)(2).
(e) Transitional assistance provided by Territories.
(i) Describe how funds allocated to the territory are to be used to cover the cost of covered discount card drugs obtained by individuals who reside in the territory, who are entitled to benefits under Medicare Part A or enrolled under Medicare Part B, and who have income at or below 135 percent of the poverty line for the contiguous United States; and
(ii) Describe how the territory will ensure that amounts received under the allotment are to be used only to provide covered discount card drugs to those individuals determined eligible for transitional assistance, as described in paragraph (e)(2)(i) of this section, and
(iii) Provide such written assurance for the requirements in paragraph (e)(2)(ii) of this section.
(3) CMS will review and approve plans submitted and make allotments to territories with approved plans.
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