; and (B) an additional amount based on criteria established by the Secretary, which may include the ability of the State, Indian tribe, or tribal organization to successfully assist individuals in seeking eligibility for Federal or State-funded programs as described in paragraph (4)(A)(ii)(II). (4) Program components (A) In general A State, Indian tribe, or tribal organization carrying out a program supported by a grant under this subsection— (i) shall use the grant funds to— (I) issue insulin cards to eligible individuals in accordance with subparagraph (B); and (II) enter into agreements with pharmacies— (aa) for such pharmacies to fill prescriptions for individuals displaying valid insulin cards that are issued in accordance with subparagraph (B) at no cost to such individuals; and (bb) for the State, Indian tribe, or tribal organization to pay such pharmacies for insulin filled for a prescription described in item (aa); and (ii) may use the grant funds to— (I) purchase insulin; or (II) assist individuals in seeking eligibility for Federal or State-funded programs which may provide coverage for insulin or otherwise assist such individuals in obtaining insulin. (B) Insulin cards (i) Application An eligible individual seeking an insulin card through a program supported by a grant under this subsection shall submit an application to the State, Indian tribe, or tribal organization receiving the grant, at such time, in such manner, and containing such information as the State, Indian tribe, or tribal organization may reasonably require for purposes of this subsection, including— (I) documentation indicating proof of— (aa) in the case of a grant awarded to a State, residency in the State; (bb) in the case of a grant awarded to an Indian tribe, membership in the Indian tribe; or (cc) in the case of a grant awarded to a tribal organization, membership in the Indian tribe or Indian community served by the tribal organization; (II) a prescription for insulin that is prescribed to the individual