At-risk beneficiary

At-risk beneficiary means a Part D eligible individual -
(1) Who is -
(i) Identified using clinical guidelines (as defined in this section);
(ii) Not an exempted beneficiary; and
(iii) Determined to be at-risk for misuse or abuse of such frequently abused drugs by a Part D plan sponsor under its drug management program in accordance with the requirements of ยง 423.153(f); or
(2) With respect to whom a Part D plan sponsor receives a notice upon the beneficiary's enrollment in such sponsor's plan that the beneficiary was identified as an at-risk beneficiary (as defined in the paragraph (1) of this definition) under the prescription drug plan in which the beneficiary was most recently enrolled and such identification had not been terminated upon disenrollment.


42 CFR § 423.100

Scoping language

As used in this part, unless otherwise specified-

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