Pharmacy benefits program

Pharmaceutical agents included on the uniform formulary shall be available to eligible covered beneficiaries through— Regulations prescribed by the Secretary to carry out clause (i) shall include the following with respect to over-the-counter drugs included on the uniform formulary: For: The cost-sharing amount for a 30-day supply of a retail generic is: The cost-sharing amount for a 30-day supply of a retail formulary is: The cost-sharing amount for a 90-day supply of a mail order generic is: The cost-sharing amount for a 90-day supply of a mail order formulary is: The cost-sharing amount for a 90-day supply of a mail order non-formulary is: 2018 $11 $28 $7 $24 $53 2019 $11 $28 $7 $24 $53 2020 $13 $33 $10 $29 $60 2021 $13 $33 $10 $29 $60 2022 $14 $38 $12 $34 $68 2023 $14 $38 $12 $34 $68 2024 $16 $43 $13 $38 $76 2025 $16 $43 $13 $38 $76 2026 $16 $48 $14 $44 $85 2027 $16 $48 $14 $44 $85 The Secretary shall determine the maintenance medications subject to the requirement under subparagraph (A). The Secretary shall ensure that— The Secretary may exempt the following prescription maintenance medications from the requirement of subparagraph (A): Notwithstanding paragraphs (2), (5), and (6), in order to encourage the use by covered beneficiaries of pharmaceutical agents that provide the best clinical effectiveness to covered beneficiaries and the Department of Defense (as determined by the Secretary, including considerations of better care, healthier people, and smarter spending), the Secretary may, upon the recommendation of the Pharmacy and Therapeutics Committee established under subsection (b) and review by the Uniform Formulary Beneficiary Advisory Panel established under subsection (c)— The Secretary shall determine the size and membership of the panel established under paragraph (1), which shall include members that represent— The program shall be— In this section: