{"data":{"id":"us/42-cfr-423.2410","jurisdiction":"us","citation":"42 CFR 423.2410","heading":"General requirements.","body":"(a) For contracts beginning in 2014 or subsequent contract years, a Part D sponsor (defined at § 423.4) is required to report the information required under § 423.2460 for each contract under this part for each contract year.\n(b) If CMS determines for a contract year that a Part D sponsor has an MLR for a contract that is less than 0.85, the Part D sponsor must remit to CMS an amount equal to the product of the following:\n(1) The total revenue of the prescription drug plan for the contract year.\n(2) The difference between 0.85 and the MLR for the contract year.\n(c) If CMS determines that a Part D sponsor has an MLR for a contract that is less than 0.85 for 3 or more consecutive contract years, CMS does not permit the enrollment of new enrollees under the contract for coverage during the second succeeding contract year.\n(d) If CMS determines that a Part D sponsor has an MLR for a contract that is less than 0.85 for 5 consecutive contract years, CMS terminates the contract under the authority at 423.509(b)(1) and (d) effective as of the second succeeding contract year.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT","Subpart X—Requirements for a Minimum Medical Loss Ratio"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"618e1f76f823f220f5befd11dffd81b6dd15431360c4b6e5ec0875d0aadd3a7f","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-423.2401","next":"us/42-cfr-423.2420"},"notice":"GroundRules: Original legal text. Not legal advice."}