Creditable prescription drug coverage
(a) Definition. Creditable prescription drug coverage means any of the following types of coverage listed in paragraph (b) of this section only if the actuarial value of the coverage equals or exceeds the actuarial value of defined standard prescription drug coverage under Part D in effect at the start of such plan year, not taking into account the value of any discount provided under section 1860D-14C of the Act or of any selected drug subsidy under section 1860D-14D of the Act, and demonstrated through (1) The use of generally accepted actuarial principles and in accordance with CMS guidelines; or (2) For group health plans not receiving a retiree drug subsidy, meeting the following requirements under the simplified creditable coverage determination methodology: (i) Provision of reasonable coverage for brand name and generic prescription drugs and biological products. (ii) Provision of reasonable access to retail pharmacies. (iii) Is designed to pay on average a minimum percent of participants' prescription drug expenses, with the percent value at 73 percent for 2027 and percent values for subsequent years to be updated by CMS in subregulatory guidance in a time and manner determined by CMS to reflect the actuarial value of defined standard prescription drug coverage under Part D.