[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2115 Engrossed in House (EH)]

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116th CONGRESS
  1st Session
                                H. R. 2115

_______________________________________________________________________

                                 AN ACT


 
  To amend titles XI and XVIII of the Social Security Act to provide 
   greater transparency for discounts provided by manufacturers, to 
 include real-time benefit information as part of a prescription drug 
plan's electronic prescription program under the Medicare program, 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 ``Public Disclosure of Drug Discounts 
and Real-Time Beneficiary Drug Cost Act''.

SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS.

    Section 1150A of the Social Security Act (42 U.S.C. 1320b-23) is 
amended--
            (1) in subsection (c), in the matter preceding paragraph 
        (1), by inserting ``(other than as permitted under subsection 
        (e))'' after ``disclosed by the Secretary''; and
            (2) by adding at the end the following new subsection:
    ``(e) Public Availability of Certain Information.--
            ``(1) In general.--In order to allow the comparison of 
        PBMs' ability to negotiate rebates, discounts, direct and 
        indirect remuneration fees, administrative fees, and price 
        concessions and the amount of such rebates, discounts, direct 
        and indirect remuneration fees, administrative fees, and price 
        concessions that are passed through to plan sponsors, beginning 
        January 1, 2020, the Secretary shall make available on the 
        Internet website of the Department of Health and Human Services 
        the information with respect to the second preceding calendar 
        year provided to the Secretary on generic dispensing rates (as 
        described in paragraph (1) of subsection (b)) and information 
        provided to the Secretary under paragraphs (2) and (3) of such 
        subsection that, as determined by the Secretary, is with 
        respect to each PBM.
            ``(2) Availability of data.--In carrying out paragraph (1), 
        the Secretary shall ensure the following:
                    ``(A) Confidentiality.--The information described 
                in such paragraph is displayed in a manner that 
                prevents the disclosure of information, with respect to 
                an individual drug or an individual plan, on rebates, 
                discounts, direct and indirect remuneration fees, 
                administrative fees, and price concessions.
                    ``(B) Class of drug.--The information described in 
                such paragraph is made available by class of drug, 
                using an existing classification system, but only if 
                the class contains such number of drugs, as specified 
                by the Secretary (but not fewer than three drugs), to 
                ensure confidentiality of proprietary information or 
                other information that is prevented to be disclosed 
                under subparagraph (A).''.

SEC. 3. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS TO INCLUDE REAL-TIME 
              BENEFIT INFORMATION AS PART OF SUCH SPONSOR'S ELECTRONIC 
              PRESCRIPTION PROGRAM UNDER THE MEDICARE PROGRAM.

    Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-
104(e)(2)) is amended--
            (1) in subparagraph (D), by striking ``To the extent'' and 
        inserting ``Except as provided in subparagraph (F), to the 
        extent''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Real-time benefit information.--
                            ``(i) In general.--Not later than January 
                        1, 2021, the program shall implement real-time 
                        benefit tools that are capable of integrating 
                        with a prescribing health care professional's 
                        electronic prescribing or electronic health 
                        record system for the transmission of formulary 
                        and benefit information in real time to 
                        prescribing health care professionals. With 
                        respect to a covered part D drug, such tools 
                        shall be capable of transmitting such 
                        information specific to an individual enrolled 
                        in a prescription drug plan. Such information 
                        shall include the following:
                                    ``(I) A list of any clinically-
                                appropriate alternatives to such drug 
                                included in the formulary of such plan.
                                    ``(II) Cost-sharing information for 
                                such drug and such alternatives, 
                                including a description of any variance 
                                in cost sharing based on the pharmacy 
                                dispensing such drug or such 
                                alternatives.
                                    ``(III) Information relating to 
                                whether such drug is included in the 
                                formulary of such plan and any prior 
                                authorization or other utilization 
                                management requirements applicable to 
                                such drug and such alternatives so 
                                included.
                            ``(ii) Electronic transmission.--The 
                        provisions of subclauses (I) and (II) of clause 
                        (ii) of subparagraph (E) shall apply to an 
                        electronic transmission described in clause (i) 
                        in the same manner as such provisions apply 
                        with respect to an electronic transmission 
                        described in clause (i) of such subparagraph.
                            ``(iii) Special rule for 2021.--The program 
                        shall be deemed to be in compliance with clause 
                        (i) for 2021 if the program complies with the 
                        provisions of section 423.160(b)(7) of title 
                        42, Code of Federal Regulations (or a successor 
                        regulation), for such year.
                            ``(iv) Rule of construction.--Nothing in 
                        this subparagraph shall be construed as to 
                        allow a real-time benefits tool to steer an 
                        individual, without the consent of the 
                        individual, to a particular pharmacy or 
                        pharmacy setting over their preferred pharmacy 
                        setting nor prohibit the designation of a 
                        preferred pharmacy under such tool.''.

SEC. 4. SENSE OF CONGRESS REGARDING THE NEED TO EXPAND COMMERCIALLY 
              AVAILABLE DRUG PRICING COMPARISON PLATFORMS.

    It is the sense of Congress that--
            (1) commercially available drug pricing comparison 
        platforms can, at no cost, help patients find the lowest price 
        for their medications at their local pharmacy;
            (2) such platforms should be integrated, to the maximum 
        extent possible, in the health care delivery ecosystem; and
            (3) pharmacy benefit managers should work to disclose 
        generic and brand name drug prices to such platforms to ensure 
        that--
                    (A) patients can benefit from the lowest possible 
                price available to them; and
                    (B) overall drug prices can be reduced as more 
                educated purchasing decisions are made based on price 
                transparency.

            Passed the House of Representatives October 28, 2019.

            Attest:

                                                                 Clerk.
116th CONGRESS

  1st Session

                               H. R. 2115

_______________________________________________________________________

                                 AN ACT

  To amend titles XI and XVIII of the Social Security Act to provide 
   greater transparency for discounts provided by manufacturers, to 
 include real-time benefit information as part of a prescription drug 
plan's electronic prescription program under the Medicare program, and 
                          for other purposes.