Applicable beneficiary
Applicable beneficiary means an individual who, on the date of dispensing a covered Part D drug (1) Is enrolled in a prescription drug plan or an MA-PD plan; (2) Is not enrolled in a qualified retiree prescription drug plan; (3) (i) For the purposes of the Coverage Gap Discount Program (A) Is not entitled to an income-related subsidy under section 1860D-14(a) of the Act; (B) Has reached or exceeded the initial coverage limit under section 1860D-2(b)(3) of the Act during the year; (C) Has not incurred costs for covered Part D drugs in the year equal to the annual out-of-pocket threshold specified in section 1860D-2(b)(4)(B) of the Act; and (D) Has a claim that