; (II) those drugs in a class that provide less clinical benefit, including greater safety concerns or a greater risk of side effects, than another drug in the same class that should be excluded from the formulary; and (III) drugs in a class with same or similar clinical benefit for which it would be appropriate for the Secretary to competitively bid (or negotiate) for placement on the formulary. (C) Consideration of AHRQ recommendations (i) In general The President, after taking into consideration the recommendations under subparagraph (B)(v), shall establish a formulary, and formulary incentives, to encourage use of covered part D drugs that— (I) have a lower cost and provide a greater clinical benefit than other drugs; (II) have a lower cost than other drugs with same or similar clinical benefit; and (III) have the same cost but provide greater clinical benefit than other drugs. (ii) Formulary incentives The formulary incentives under clause (i) may be in the form of one or more of the following: (I) Tiered copayments. (II) Reference pricing. (III) Prior authorization. (IV) Step therapy. (V) Medication therapy management. (VI) Generic drug substitution. (iii) Flexibility In applying such formulary incentives the President may decide not to impose any cost-sharing for a covered part D drug for which— (I) the elimination of cost sharing would be expected to increase compliance with a drug regimen; and (II) compliance would be expected to produce savings under part A or B or both. (3) Limitations on formulary In any formulary established under this subsection, the formulary may not be changed during a year, except— (A) to add a generic version of a covered part D drug that entered the market; (B) to remove such a drug for which a safety problem is found