[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1300 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1300

  To prohibit a health plan from contracting with a pharmacy benefit 
 manager (PBM) unless the PBM satisfies certain requirements, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 19, 2003

 Ms. Cantwell introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To prohibit a health plan from contracting with a pharmacy benefit 
 manager (PBM) unless the PBM satisfies certain requirements, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Prescription Drug Consumer 
Information Act of 2003''.

SEC. 2. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

    (a) Amendments to the Public Health Service Act Relating to the 
Group Market.--
            (1) In general.--Subpart 2 of part A of title XXVII of the 
        Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
        amended by adding at the end the following:

``SEC. 2707. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

    ``Notwithstanding any other provision of law, a group health plan, 
and a health insurance issuer providing health insurance coverage in 
connection with a group health plan, shall not enter into a contract 
with any pharmacy benefit manager (in this section referred to as a 
`PBM') to manage the prescription drug coverage provided under such 
plan or insurance coverage, or to control the costs of such 
prescription drug coverage, unless the PBM satisfies the following 
requirements:
            ``(1) The PBM is not owned by a pharmaceutical 
        manufacturing company.
            ``(2) The PBM agrees to pass along any cost savings 
        negotiated with a pharmacy to the group health plan or the 
        health insurance issuer.
            ``(3) The PBM agrees to make public on an annual basis the 
        percent of manufacturer's rebates received by the PBM that is 
        passed back to the group health plan or the health insurance 
        issuer on a drug-by-drug basis.
            ``(4) The PBM agrees to provide, at least annually, the 
        group health plan or the health insurance issuer with all 
        financial and utilization information requested by the plan or 
        issuer relating to the provision of benefits to eligible 
        enrollees through the PBM and all financial and utilization 
        information relating to services provided to the plan or 
        issuer. A PBM providing information under this paragraph may 
        designate that information as confidential. Information 
        designated as confidential by a PBM and provided to a plan or 
        issuer under this paragraph may not be disclosed to any person 
        without the consent of the PBM.
            ``(5) The PBM agrees to provide, at least annually, the 
        group health plan or the health insurance issuer with all 
        financial terms and arrangements for remuneration of any kind 
        that apply between the PBM and any prescription drug 
        manufacturer or labeler, including formulary management and 
        drug-switch programs, educational support, claims processing 
        and pharmacy network fees that are charged from retail 
        pharmacies and data sales fees.''.
            (2) Effective date.--The amendment made by this subsection 
        shall apply to group health plans and health insurance issuers 
        in connection with group health plans for plan years beginning 
        on or after the date of enactment of this Act.
    (b) Amendment to the Public Health Service Act Relating to the 
Individual Market.--
            (1) In general.--The first subpart 3 of part B of title 
        XXVII of the Public Health Service Act (42 U.S.C. 300gg-51 et 
        seq.) is amended--
                    (A) by redesignating such subpart as subpart 2; and
                    (B) by adding at the end the following:

``SEC. 2753. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

    ``The provisions of section 2707 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as they apply to a group health plan and a health 
insurance issuer providing health insurance coverage under that 
section.''.
            (2) Effective date.--The amendment made by paragraph (1)(B) 
        shall apply with respect to health insurance coverage offered, 
        sold, issued, renewed, in effect, or operated in the individual 
        market on or after the date of enactment of this Act.
    (c) Employee Retirement Income Security Act of 1974.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185 et seq.) is amended by adding at the end the 
        following:

``SEC. 714. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

    ``The provisions of section 2707 of the Public Health Service Act 
shall apply to a group health plan, and a health insurance issuer 
providing health insurance coverage in connection with a group health 
plan, in the same manner as such provisions apply to a group health 
plan and a health insurance issuer providing health insurance coverage 
under that section.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 is 
        amended by inserting after the item relating to section 713 the 
        following:

``Sec. 714. Pharmacy benefit managers transparency requirements.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        the date of enactment of this Act.

SEC. 3. DISCLOSURE OF RETAIL PRICES OF PHARMACEUTICALS.

    The Secretary of Health and Human Services shall promulgate 
regulations requiring a pharmacy to disclose the retail cost of a 
prescription drug upon request by a consumer.
                                 <all>