[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4507 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 4507

To amend the Employee Retirement Income Security Act of 1974 to promote 
transparency in health coverage and reform pharmacy benefit management 
  services with respect to group health plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 10, 2023

 Mr. Good of Virginia (for himself and Mr. DeSaulnier) introduced the 
 following bill; which was referred to the Committee on Education and 
    the Workforce, and in addition to the Committees on Energy and 
     Commerce, and Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend the Employee Retirement Income Security Act of 1974 to promote 
transparency in health coverage and reform pharmacy benefit management 
  services with respect to group health plans, 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 ``Transparency in Coverage Act of 
2023''.

SEC. 2. PROMOTING GROUP HEALTH PLAN AND GROUP HEALTH INSURANCE COVERAGE 
              PRICE TRANSPARENCY.

    (a) In General.--
            (1) ERISA.--
                    (A) In general.--Section 719 of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1185h) is amended to read as follows:

``SEC. 719. PRICE TRANSPARENCY REQUIREMENTS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall make available 
to the public accurate and timely disclosures of the following 
information:
            ``(1) Claims payment policies and practices.
            ``(2) Periodic financial disclosures.
            ``(3) Data on enrollment.
            ``(4) Data on disenrollment.
            ``(5) Data on the number of claims that are denied.
            ``(6) Data on rating practices.
            ``(7) Information on cost-sharing and payments with respect 
        to any out-of-network coverage (or with respect to any item and 
        service furnished under such a plan or such group health 
        insurance coverage that does not use a network of providers).
            ``(8) Information on participant and beneficiary rights 
        under this part.
            ``(9) Rate and payment information described in subsection 
        (d).
            ``(10) Other information as determined appropriate by the 
        Secretary.
Rate and payment information described in paragraph (9) shall be made 
available to the public not later than January 10, 2025, and not later 
than the tenth day of every month thereafter, in the manner described 
in subsection (d)(2)(A), and, beginning on January 1, 2027, in real-
time through an application program interface (or successor technology) 
described in subsection (d)(2)(B).
    ``(b) Use of Plain Language.--The information required to be 
submitted under subsection (a) shall be provided in plain language. The 
term `plain language' means language that the intended audience, 
including individuals with limited English proficiency, can readily 
understand and use because that language is clear, concise, well-
organized, accurately describes the information, and follows other best 
practices of plain language writing. The Secretary, jointly with the 
Secretary of Health and Human Services and the Secretary of Labor, 
shall develop and issue standards for plain language writing for 
purposes of this section and shall develop a standardized reporting 
template and standardized definitions of terms to allow for comparison 
across group health plans and health insurance coverage.
    ``(c) Cost Sharing Transparency.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall, upon request of a participant or beneficiary and in a 
        timely manner, provide to the participant or beneficiary a 
        statement of the amount of cost-sharing (including deductibles, 
        copayments, and coinsurance) under the participant's or 
        beneficiary's plan or coverage that the participant or 
        beneficiary would be responsible for paying with respect to the 
        furnishing of a specific item or service by a provider. At a 
        minimum, such information shall include the information 
        specified in paragraph (2) and shall be made available at no 
        cost to the participant or beneficiary through a self-service 
        tool that meets the requirements of paragraph (3) or through a 
        paper or phone disclosure, at the option of the participant or 
        beneficiary, that meets such requirements as the Secretary may 
        specify.
            ``(2) Specified information.--For purposes of paragraph 
        (1), the information specified in this paragraph is, with 
        respect to an item or service for which benefits are available 
        under a group health plan or group health insurance coverage 
        (as applicable) furnished by a health care provider to a 
        participant or beneficiary of such plan or coverage, the 
        following:
                    ``(A) If such provider is a participating provider 
                with respect to such item or service, the in-network 
                rate (as defined in subsection (f)) for such item or 
                service and for any other item or service that is 
                inherent in the furnishing of the item or service that 
                is the subject of such request.
                    ``(B) If such provider is not a participating 
                provider, the allowed amount, percentage of billed 
                charges, or other rate that such plan or coverage will 
                recognize as payment for such item or service, along 
                with a notice that such individual may be liable for 
                additional charges billed by such provider.
                    ``(C) The estimated amount of cost sharing 
                (including deductibles, copayments, and coinsurance) 
                that the participant or beneficiary will incur for such 
                item or service (which, in the case such item or 
                service is to be furnished by a provider described in 
                subparagraph (B), shall be calculated using the amount 
                or rate described in such subparagraph (or, in the case 
                such plan or issuer uses a percentage of billed charges 
                to determined the amount of payment for such provider, 
                using a reasonable estimate of such percentage of such 
                charges)).
                    ``(D) The amount the participant or beneficiary has 
                already accumulated with respect to any deductible or 
                out of pocket maximum under the plan or coverage 
                (broken down, in the case separate deductibles or 
                maximums apply to separate participants and 
                beneficiaries enrolled in the plan or coverage, by such 
                separate deductibles or maximums, in addition to any 
                cumulative deductible or maximum).
                    ``(E) Any shared savings or other benefit available 
                to the participant or beneficiary with respect to such 
                item or service.
                    ``(F) In the case such plan or coverage imposes any 
                frequency or volume limitations with respect to such 
                item or service (excluding medical necessity 
                determinations), the amount that such participant or 
                beneficiary has accrued towards such limitation with 
                respect to such item or service.
                    ``(G) Any prior authorization, concurrent review, 
                step therapy, fail first, or similar requirements 
                applicable to coverage of such item or service under 
                such plan or group health insurance coverage.
            ``(3) Self-service tool.--For purposes of paragraph (1), a 
        self-service tool established by a group health plan or health 
        insurance issuer offering group health insurance coverage meets 
        the requirements of this paragraph if such tool--
                    ``(A) is based on an Internet website, mobile 
                application, or other platform determined appropriate 
                by the Secretary;
                    ``(B) provides for real-time responses to requests 
                described in paragraph (1);
                    ``(C) is updated in a manner such that information 
                provided through such tool is accurate at the time such 
                request is made;
                    ``(D) allows such a request to be made with respect 
                to an item or service furnished by--
                            ``(i) a specific provider that is a 
                        participating provider with respect to such 
                        item or service;
                            ``(ii) all providers that are participating 
                        providers with respect to such plan and such 
                        item or service for purposes of facilitating 
                        price comparisons; or
                            ``(iii) a provider that is not described in 
                        clause (ii); and
                    ``(E) provides that such a request may be made with 
                respect to an item or service through use of the 
                billing code for such item or service or through use of 
                a descriptive term for such item or service.
        The Secretary may require such tool, as a condition of 
        complying with subparagraph (E), to link multiple billing codes 
        to a single descriptive term if the Secretary determines that 
        the billing codes to be so linked correspond to items and 
        services.
            ``(4) Provider tool.--A group health plan, and a health 
        insurance issuer offering group health insurance coverage, 
        shall permit providers to learn the amount of cost-sharing 
        (including deductibles, copayments, and coinsurance) that would 
        apply under an individual's plan or coverage that the 
        individual would be responsible for paying with respect to the 
        furnishing of a specific item or service by another provider in 
        a timely manner upon the request of the provider and with the 
        consent of such individual in the same manner and to the same 
        extent as if such request has been made by such individual. As 
        part of any tool used to facilitate such requests from a 
        provider, such plan or issuer offering health insurance 
        coverage may include functionality that--
                    ``(A) allows providers to submit the notifications 
                to such plan or coverage required under section 2799B-6 
                of the Public Health Service Act; and
                    ``(B) provides for notifications required under 
                section 716(f) to such an individual.
    ``(d) Rate and Payment Information.--
            ``(1) In general.--For purposes of subsection (a)(9), the 
        rate and payment information described in this subsection is, 
        with respect to a group health plan or group health insurance 
        coverage (as applicable), the following:
                    ``(A) With respect to each item or service (other 
                than a drug) for which benefits are available under 
                such plan or coverage, the in-network rate (in a dollar 
                amount) in effect as of the first day of the plan year 
                during which such information is submitted with each 
                provider (identified by national provider identifier) 
                that is a participating provider with respect to such 
                item or service (or, in the case such rate is not 
                available in a dollar amount, such formulae, pricing 
                methodologies, or other information used to calculate 
                such rate).
                    ``(B) With respect to each dosage form and 
                indication of each drug (identified by national drug 
                code) for which benefits are available under such plan 
                or coverage--
                            ``(i) the in-network rate (in a dollar 
                        amount) in effect as of the first day of the 
                        plan year during which such information is 
                        submitted with each provider (identified by 
                        national provider identifier) that is a 
                        participating provider with respect to such 
                        drug (or, in the case such rate is not 
                        available in a dollar amount, such formulae, 
                        pricing methodologies, or other information 
                        used to calculate such rate); and
                            ``(ii) the average amount paid by such plan 
                        (net of rebates, discounts, and price 
                        concessions) for such drug dispensed or 
                        administered during the 90-day period beginning 
                        180 days before such date of submission to each 
                        provider that was a participating provider with 
                        respect to such drug, broken down by each such 
                        provider (identified by national provider 
                        identifier), other than such an amount paid to 
                        a provider that, during such period, submitted 
                        fewer than 20 claims for such drug to such plan 
                        or coverage.
                    ``(C) With respect to each item or service for 
                which benefits are available under such plan or 
                coverage, the amount billed, and the amount allowed by 
                the plan or coverage, for each such item or service 
                furnished during the 90-day period specified in 
                subparagraph (B) by a provider that was not a 
                participating provider with respect to such item or 
                service, broken down by each such provider (identified 
                by national provider identifier), other than items and 
                services with respect to which fewer than 20 claims for 
                such item or service were submitted to such plan or 
                coverage during such period.
        Such rate and payment information shall be made available with 
        respect to each individual item or service, regardless of 
        whether such item or service is paid for as part of a bundled 
        payment, episode of care, value-based payment arrangement, or 
        otherwise.
            ``(2) Manner of publication.--
                    ``(A) In general.--Rate and payment information 
                required to be made available under subsection (a)(9) 
                shall be so made available in dollar amounts through 3 
                separate machine-readable files corresponding to the 
                information described in each of subparagraphs (A) 
                through (C) of paragraph (1) that meet such 
                requirements as specified by the Secretary not later 
                than 180 days after the date of the enactment of this 
                paragraph through rulemaking. Such requirements shall 
                ensure that such files are limited to an appropriate 
                size, do not include information that is duplicative of 
                information contained in the same file or in other 
                files made available under such subsection, are made 
                available in a widely-available format that allows for 
                information contained in such files to be compared 
                across group health plans and group health insurance 
                coverage, and are accessible to individuals at no cost 
                and without the need to establish a user account or 
                provide other credentials.
                    ``(B) Real-time provision of information.--
                            ``(i) In general.--Subject to clause (ii), 
                        beginning January 1, 2026, rate and payment 
                        information required to be made available by a 
                        group health plan or health insurance issuer 
                        under subsection (a)(9) shall, in addition to 
                        being made available in the manner described in 
                        subparagraph (A), be made available through an 
                        application program interface (or successor 
                        technology) that provides access to such 
                        information in real time and that meets such 
                        technical standards as may be specified by the 
                        Secretary.
                            ``(ii) Exemption for certain plans or 
                        coverage.--Clause (i) shall not apply with 
                        respect to information described in such clause 
                        required to be made available by a group health 
                        plan or health insurance issuer offering health 
                        insurance coverage if such plan or coverage, as 
                        applicable, provides benefits for fewer than 
                        500 participants and beneficiaries.
            ``(3) User guide.--The Secretary, Secretary of Health and 
        Human Services, and Secretary of the Treasury shall jointly 
        make available to the public instructions written in plain 
        language explaining how individuals may search for information 
        described in paragraph (1) in files submitted in accordance 
        with paragraph (2).
            ``(4) Annual summary.--For each year (beginning with 2025), 
        each group health plan and health insurance issuer offering 
        group health insurance coverage shall make public a machine-
        readable file meeting such standards as established by the 
        Secretary under paragraph (2) containing a summary of all rate 
        and payment information made public by such plan or issuer with 
        respect to such plan or coverage during such year (such as 
        averages of all such information so made public).
    ``(e) Attestation.--Each group health plan and health insurance 
issuer offering group health insurance coverage shall annually submit 
to the Secretary an attestation of such plan's or such coverage's 
compliance with the provisions of this section along with a link to 
disclosures made in accordance with subsection (a).
    ``(f) Definitions.--In this subsection:
            ``(1) Participating provider.--The term `participating 
        provider' has the meaning given such term in section 716 and 
        includes a participating facility.
            ``(2) In-network rate.--The term `in-network rate' means, 
        with respect to a group health plan or group health insurance 
        coverage and an item or service furnished by a provider that is 
        a participating provider with respect to such plan or coverage 
        and item or service, the contracted rate (reflected as a dollar 
        amount) in effect between such plan or coverage and such 
        provider for such item or service.''.
                    (B) Clerical amendment.--The table of contents in 
                section 1 of such Act is amended by striking the item 
                relating to section 719 and inserting the following new 
                item:

``Sec. 719. Price transparency requirements.''.
            (2) IRC.--
                    (A) In general.--Section 9819 of the Internal 
                Revenue Code of 1986 is amended to read as follows:

``SEC. 9819. PRICE TRANSPARENCY REQUIREMENTS.

    ``(a) In General.--A group health plan shall make available to the 
public accurate and timely disclosures of the following information:
            ``(1) Claims payment policies and practices.
            ``(2) Periodic financial disclosures.
            ``(3) Data on enrollment.
            ``(4) Data on disenrollment.
            ``(5) Data on the number of claims that are denied.
            ``(6) Data on rating practices.
            ``(7) Information on cost-sharing and payments with respect 
        to any out-of-network coverage (or with respect to any item and 
        service furnished under such a plan that does not use a network 
        of providers).
            ``(8) Information on participant and beneficiary rights 
        under this part.
            ``(9) Rate and payment information described in subsection 
        (d).
            ``(10) Other information as determined appropriate by the 
        Secretary.
Rate and payment information described in paragraph (9) shall be made 
available to the public not later than January 10, 2025, and not later 
than the tenth day of every month thereafter, in the manner described 
in subsection (d)(2)(A), and, beginning on January 1, 2027, in real-
time through an application program interface (or successor technology) 
described in subsection (d)(2)(B).
    ``(b) Use of Plain Language.--The information required to be 
submitted under subsection (a) shall be provided in plain language. The 
term `plain language' means language that the intended audience, 
including individuals with limited English proficiency, can readily 
understand and use because that language is clear, concise, well-
organized, accurately describes the information, and follows other best 
practices of plain language writing. The Secretary, jointly with the 
Secretary of Health and Human Services and the Secretary of Labor, 
shall develop and issue standards for plain language writing for 
purposes of this section and shall develop a standardized reporting 
template and standardized definitions of terms to allow for comparison 
across group health plans and health insurance coverage.
    ``(c) Cost Sharing Transparency.--
            ``(1) In general.--A group health plan shall, upon request 
        of a participant or beneficiary and in a timely manner, provide 
        to the participant or beneficiary a statement of the amount of 
        cost-sharing (including deductibles, copayments, and 
        coinsurance) under the participant's or beneficiary's plan that 
        the participant or beneficiary would be responsible for paying 
        with respect to the furnishing of a specific item or service by 
        a provider. At a minimum, such information shall include the 
        information specified in paragraph (2) and shall be made 
        available at no cost to the participant or beneficiary through 
        a self-service tool that meets the requirements of paragraph 
        (3) or through a paper or phone disclosure, at the option of 
        the participant or beneficiary, that meets such requirements as 
        the Secretary may specify.
            ``(2) Specified information.--For purposes of paragraph 
        (1), the information specified in this paragraph is, with 
        respect to an item or service for which benefits are available 
        under a group health plan furnished by a health care provider 
        to a participant or beneficiary of such plan, the following:
                    ``(A) If such provider is a participating provider 
                with respect to such item or service, the in-network 
                rate (as defined in subsection (f)) for such item or 
                service and for any other item or service that is 
                inherent in the furnishing of the item or service that 
                is the subject of such request.
                    ``(B) If such provider is not a participating 
                provider, the allowed amount, percentage of billed 
                charges, or other rate that such plan will recognize as 
                payment for such item or service, along with a notice 
                that such individual may be liable for additional 
                charges billed by such provider.
                    ``(C) The estimated amount of cost sharing 
                (including deductibles, copayments, and coinsurance) 
                that the participant or beneficiary will incur for such 
                item or service (which, in the case such item or 
                service is to be furnished by a provider described in 
                subparagraph (B), shall be calculated using the amount 
                or rate described in such subparagraph (or, in the case 
                such plan uses a percentage of billed charges to 
                determined the amount of payment for such provider, 
                using a reasonable estimate of such percentage of such 
                charges)).
                    ``(D) The amount the participant or beneficiary has 
                already accumulated with respect to any deductible or 
                out of pocket maximum under the plan (broken down, in 
                the case separate deductibles or maximums apply to 
                separate participants and beneficiaries enrolled in the 
                plan, by such separate deductibles or maximums, in 
                addition to any cumulative deductible or maximum).
                    ``(E) Any shared savings or other benefit available 
                to the participant or beneficiary with respect to such 
                item or service.
                    ``(F) In the case such plan imposes any frequency 
                or volume limitations with respect to such item or 
                service (excluding medical necessity determinations), 
                the amount that such participant or beneficiary has 
                accrued towards such limitation with respect to such 
                item or service.
                    ``(G) Any prior authorization, concurrent review, 
                step therapy, fail first, or similar requirements 
                applicable to coverage of such item or service under 
                such plan.
            ``(3) Self-service tool.--For purposes of paragraph (1), a 
        self-service tool established by a group health plan meets the 
        requirements of this paragraph if such tool--
                    ``(A) is based on an Internet website, mobile 
                application, or other platform determined appropriate 
                by the Secretary;
                    ``(B) provides for real-time responses to requests 
                described in paragraph (1);
                    ``(C) is updated in a manner such that information 
                provided through such tool is accurate at the time such 
                request is made;
                    ``(D) allows such a request to be made with respect 
                to an item or service furnished by--
                            ``(i) a specific provider that is a 
                        participating provider with respect to such 
                        item or service;
                            ``(ii) all providers that are participating 
                        providers with respect to such item or service 
                        for purposes of facilitating price comparisons; 
                        or
                            ``(iii) a provider that is not described in 
                        clause (ii); and
                    ``(E) provides that such a request may be made with 
                respect to an item or service through use of the 
                billing code for such item or service or through use of 
                a descriptive term for such item or service.
        The Secretary may require such tool, as a condition of 
        complying with subparagraph (E), to link multiple billing codes 
        to a single descriptive term if the Secretary determines that 
        the billing codes to be so linked correspond to items and 
        services.
            ``(4) Provider tool.--A group health plan shall permit 
        providers to learn the amount of cost-sharing (including 
        deductibles, copayments, and coinsurance) that would apply 
        under an individual's plan that the individual would be 
        responsible for paying with respect to the furnishing of a 
        specific item or service by another provider in a timely manner 
        upon the request of the provider and with the consent of such 
        individual in the same manner and to the same extent as if such 
        request has been made by such individual. As part of any tool 
        used to facilitate such requests from a provider, such plan may 
        include functionality that--
                    ``(A) allows providers to submit the notifications 
                to such plan or coverage required under section 2799B-6 
                of the Public Health Services Act; and
                    ``(B) provides for notifications required under 
                section 9816(f) to such an individual.
    ``(d) Rate and Payment Information.--
            ``(1) In general.--For purposes of subsection (a)(9), the 
        rate and payment information described in this subsection is, 
        with respect to a group health plan, the following:
                    ``(A) With respect to each item or service (other 
                than a drug) for which benefits are available under 
                such plan, the in-network rate (in a dollar amount) in 
                effect as of the first day of the plan year during 
                which such information is submitted with each provider 
                (identified by national provider identifier) that is a 
                participating provider with respect to such item or 
                service (or, in the case such rate is not available in 
                a dollar amount, such formulae, pricing methodologies, 
                or other information used to calculate such rate).
                    ``(B) With respect to each dosage form and 
                indication of each drug (identified by national drug 
                code) for which benefits are available under such 
                plan--
                            ``(i) the in-network rate (in a dollar 
                        amount) in effect as of the first day of the 
                        plan year during which such information is 
                        submitted with each provider (identified by 
                        national provider identifier) that is a 
                        participating provider with respect to such 
                        drug (or, in the case such rate is not 
                        available in a dollar amount, such formulae, 
                        pricing methodologies, or other information 
                        used to calculate such rate); and
                            ``(ii) the average amount paid by such plan 
                        (net of rebates, discounts, and price 
                        concessions) for such drug dispensed or 
                        administered during the 90-day period beginning 
                        180 days before such date of submission to each 
                        provider that was a participating provider with 
                        respect to such drug, broken down by each such 
                        provider (identified by national provider 
                        identifier), other than such an amount paid to 
                        a provider that, during such period, submitted 
                        fewer than 20 claims for such drug to such plan 
                        or coverage.
                    ``(C) With respect to each item or service for 
                which benefits are available under such plan, the 
                amount billed, and the amount allowed by the plan, for 
                each such item or service furnished during the 90-day 
                period specified in subparagraph (B) by a provider that 
                was not a participating provider with respect to such 
                item or service, broken down by each such provider 
                (identified by national provider identifier), other 
                than items and services with respect to which fewer 
                than 20 claims for such item or service were submitted 
                to such plan or coverage during such period.
        Such rate and payment information shall be made available with 
        respect to each individual item or service, regardless of 
        whether such item or service is paid for as part of a bundled 
        payment, episode of care, value-based payment arrangement, or 
        otherwise.
            ``(2) Manner of publication.--
                    ``(A) In general.--Rate and payment information 
                required to be made available under subsection (a)(9) 
                shall be so made available in dollar amounts through 3 
                separate machine-readable files corresponding to the 
                information described in each of subparagraphs (A) 
                through (C) of paragraph (1) that meet such 
                requirements as specified by the Secretary not later 
                than 180 days after the date of the enactment of this 
                paragraph through rulemaking. Such requirements shall 
                ensure that such files are limited to an appropriate 
                size, do not include information that is duplicative of 
                information contained in other files made available 
                under such subsection, are made available in a widely-
                available format that allows for information contained 
                in such files to be compared across group health plans, 
                and are accessible to individuals at no cost and 
                without the need to establish a user account or provide 
                other credentials.
                    ``(B) Real-time provision of information.--
                            ``(i) In general.--Subject to clause (ii), 
                        beginning January 1, 2026, rate and payment 
                        information required to be made available by a 
                        group health plan under subsection (a)(9) 
                        shall, in addition to being made available in 
                        the manner described in subparagraph (A), be 
                        made available through an application program 
                        interface (or successor technology) that 
                        provides access to such information in real 
                        time and that meets such technical standards as 
                        may be specified by the Secretary.
                            ``(ii) Exemption for certain plans and 
                        coverage.--Clause (i) shall not apply with 
                        respect to information described in such clause 
                        required to be made available by a group health 
                        plan if such plan provides benefits for fewer 
                        than 500 participants and beneficiaries.
            ``(3) User guide.--The Secretary, Secretary of Health and 
        Human Services, and Secretary of Labor shall jointly make 
        available to the public instructions written in plain language 
        explaining how individuals may search for information described 
        in paragraph (1) in files submitted in accordance with 
        paragraph (2).
            ``(4) Annual summary.--For each year (beginning with 2025), 
        each group health plan shall make public a machine-readable 
        file meeting such standards as established by the Secretary 
        under paragraph (2) containing a summary of all rate and 
        payment information made public by such plan with respect to 
        such plan or coverage during such year (such as averages of all 
        such information so made public).
    ``(e) Attestation.--Each group health plan shall annually submit to 
the Secretary an attestation of such plan's compliance with the 
provisions of this section along with a link to disclosures made in 
accordance with subsection (a).
    ``(f) Definitions.--In this subsection:
            ``(1) Participating provider.--The term `participating 
        provider' has the meaning given such term in section 9816 and 
        includes a participating facility.
            ``(2) In-network rate.--The term `in-network rate' means, 
        with respect to a group health plan and an item or service 
        furnished by a provider that is a participating provider with 
        respect to such plan and item or service, the contracted rate 
        (reflected as a dollar amount) in effect between such plan and 
        such provider for such item or service.''.
                    (B) Clerical amendment.--The item relating to 
                section 9819 in the table of sections for subchapter B 
                of chapter 100 of the Internal Revenue Code of 1986 is 
                amended to read as follows:

``Sec. 9819. Price transparency requirements.''.
            (3) PHSA.--Section 2799A-4 of the Public Health Service Act 
        (42 U.S.C. 300gg-114) is amended to read as follows:

``SEC. 2799A-4. PRICE TRANSPARENCY REQUIREMENTS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group or individual health insurance coverage, shall 
make available to the public accurate and timely disclosures of the 
following information:
            ``(1) Claims payment policies and practices.
            ``(2) Periodic financial disclosures.
            ``(3) Data on enrollment.
            ``(4) Data on disenrollment.
            ``(5) Data on the number of claims that are denied.
            ``(6) Data on rating practices.
            ``(7) Information on cost-sharing and payments with respect 
        to any out-of-network coverage (or with respect to any item and 
        service furnished under such a plan or such group or individual 
        health insurance coverage that does not use a network of 
        providers).
            ``(8) Information on enrollee rights under this part.
            ``(9) Rate and payment information described in subsection 
        (d).
            ``(10) Other information as determined appropriate by the 
        Secretary.
Rate and payment information described in paragraph (9) shall be made 
available to the public not later than January 10, 2025, and not later 
than the tenth day of every month thereafter, in the manner described 
in subsection (d)(2)(A), and, beginning on January 1, 2027, in real-
time through an application program interface (or successor technology) 
described in subsection (d)(2)(B).
    ``(b) Use of Plain Language.--The information required to be 
submitted under subsection (a) shall be provided in plain language. The 
term `plain language' means language that the intended audience, 
including individuals with limited English proficiency, can readily 
understand and use because that language is clear, concise, well-
organized, accurately describes the information, and follows other best 
practices of plain language writing. The Secretary, jointly with the 
Secretary of Labor and the Secretary of the Treasury, shall develop and 
issue standards for plain language writing for purposes of this section 
and shall develop a standardized reporting template and standardized 
definitions of terms to allow for comparison across group health plans 
and health insurance coverage.
    ``(c) Cost Sharing Transparency.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group or individual health insurance 
        coverage, shall, upon request of an enrollee and in a timely 
        manner, provide to the enrollee a statement of the amount of 
        cost-sharing (including deductibles, copayments, and 
        coinsurance) under the enrollee's plan or coverage that the 
        enrollee would be responsible for paying with respect to the 
        furnishing of a specific item or service by a provider. At a 
        minimum, such information shall include the information 
        specified in paragraph (2) and shall be made available at no 
        cost to the enrollee through a self-service tool that meets the 
        requirements of paragraph (3) or through a paper or phone 
        disclosure, at the option of the enrollee, that meets such 
        requirements as the Secretary may specify.
            ``(2) Specified information.--For purposes of paragraph 
        (1), the information specified in this paragraph is, with 
        respect to an item or service for which benefits are available 
        under a group health plan or group or individual health 
        insurance coverage (as applicable) furnished by a health care 
        provider to an enrollee of such plan or coverage, the 
        following:
                    ``(A) If such provider is a participating provider 
                with respect to such item or service, the in-network 
                rate (as defined in subsection (f)) for such item or 
                service and for any other item or service that is 
                inherent in the furnishing of the item or service that 
                is the subject of such request.
                    ``(B) If such provider is not a participating 
                provider, the allowed amount, percentage of billed 
                charges, or other rate that such plan or coverage will 
                recognize as payment for such item or service, along 
                with a notice that such enrollee may be liable for 
                additional charges billed by such provider.
                    ``(C) The estimated amount of cost sharing 
                (including deductibles, copayments, and coinsurance) 
                that the enrollee will incur for such item or service 
                (which, in the case such item or service is to be 
                furnished by a provider described in subparagraph (B), 
                shall be calculated using the amount or rate described 
                in such subparagraph (or, in the case such plan or 
                issuer uses a percentage of billed charges to 
                determined the amount of payment for such provider, 
                using a reasonable estimate of such percentage of such 
                charges)).
                    ``(D) The amount the enrollee has already 
                accumulated with respect to any deductible or out of 
                pocket maximum under the plan or coverage (broken down, 
                in the case separate deductibles or maximums apply to 
                separate enrollees in the plan or coverage, by such 
                separate deductibles or maximums, in addition to any 
                cumulative deductible or maximum).
                    ``(E) Any shared savings or other benefit available 
                to the enrollee with respect to such item or service.
                    ``(F) In the case such plan or coverage imposes any 
                frequency or volume limitations with respect to such 
                item or service (excluding medical necessity 
                determinations), the amount that such enrollee has 
                accrued towards such limitation with respect to such 
                item or service.
                    ``(G) Any prior authorization, concurrent review, 
                step therapy, fail first, or similar requirements 
                applicable to coverage of such item or service under 
                such plan or group or individual health insurance 
                coverage.
            ``(3) Self-service tool.--For purposes of paragraph (1), a 
        self-service tool established by a group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage meets the requirements of this paragraph if such 
        tool--
                    ``(A) is based on an Internet website, mobile 
                application, or other platform determined appropriate 
                by the Secretary;
                    ``(B) provides for real-time responses to requests 
                described in paragraph (1);
                    ``(C) is updated in a manner such that information 
                provided through such tool is accurate at the time such 
                request is made;
                    ``(D) allows such a request to be made with respect 
                to an item or service furnished by--
                            ``(i) a specific provider that is a 
                        participating provider with respect to such 
                        item or service;
                            ``(ii) all providers that are participating 
                        providers with respect to such plan and such 
                        item or service for purposes of facilitating 
                        price comparisons; or
                            ``(iii) a provider that is not described in 
                        clause (ii); and
                    ``(E) provides that such a request may be made with 
                respect to an item or service through use of the 
                billing code for such item or service or through use of 
                a descriptive term for such item or service.
        The Secretary may require such tool, as a condition of 
        complying with subparagraph (E), to link multiple billing codes 
        to a single descriptive term if the Secretary determines that 
        the billing codes to be so linked correspond to items and 
        services.
            ``(4) Provider tool.--A group health plan, and a health 
        insurance issuer offering group or individual health insurance 
        coverage, shall permit providers to learn the amount of cost-
        sharing (including deductibles, copayments, and coinsurance) 
        that would apply under an individual's plan or coverage that 
        the individual would be responsible for paying with respect to 
        the furnishing of a specific item or service by another 
        provider in a timely manner upon the request of the provider 
        and with the consent of such individual in the same manner and 
        to the same extent as if such request has been made by such 
        individual. As part of any tool used to facilitate such 
        requests from a provider, such plan or issuer offering health 
        insurance coverage may include functionality that--
                    ``(A) allows providers to submit the notifications 
                to such plan or coverage required under section 2799B-
                6; and
                    ``(B) provides for notifications required under 
                section 2799A-1(f) to such an individual.
    ``(d) Rate and Payment Information.--
            ``(1) In general.--For purposes of subsection (a)(9), the 
        rate and payment information described in this subsection is, 
        with respect to a group health plan or group or individual 
        health insurance coverage (as applicable), the following:
                    ``(A) With respect to each item or service (other 
                than a drug) for which benefits are available under 
                such plan or coverage, the in-network rate (in a dollar 
                amount) in effect as of the first day of the plan year 
                during which such information is submitted with each 
                provider (identified by national provider identifier) 
                that is a participating provider with respect to such 
                item or service (or, in the case such rate is not 
                available in a dollar amount, such formulae, pricing 
                methodologies, or other information used to calculate 
                such rate).
                    ``(B) With respect to each dosage form and 
                indication of each drug (identified by national drug 
                code) for which benefits are available under such plan 
                or coverage--
                            ``(i) the in-network rate (in a dollar 
                        amount) in effect as of the first day of the 
                        plan year during which such information is 
                        submitted with each provider (identified by 
                        national provider identifier) that is a 
                        participating provider with respect to such 
                        drug (or, in the case such rate is not 
                        available in a dollar amount, such formulae, 
                        pricing methodologies, or other information 
                        used to calculate such rate); and
                            ``(ii) the average amount paid by such plan 
                        (net of rebates, discounts, and price 
                        concessions) for such drug dispensed or 
                        administered during the 90-day period beginning 
                        180 days before such date of submission to each 
                        provider that was a participating provider with 
                        respect to such drug, broken down by each such 
                        provider (identified by national provider 
                        identifier), other than such an amount paid to 
                        a provider that, during such period, submitted 
                        fewer than 20 claims for such drug to such plan 
                        or coverage.
                    ``(C) With respect to each item or service for 
                which benefits are available under such plan or 
                coverage, the amount billed, and the amount allowed by 
                the plan or coverage, for each such item or service 
                furnished during the 90-day period specified in 
                subparagraph (B) by a provider that was not a 
                participating provider with respect to such item or 
                service, broken down by each such provider (identified 
                by national provider identifier), other than items and 
                services with respect to which fewer than 20 claims for 
                such item or service were submitted to such plan or 
                coverage during such period.
        Such rate and payment information shall be made available with 
        respect to each individual item or service, regardless of 
        whether such item or service is paid for as part of a bundled 
        payment, episode of care, value-based payment arrangement, or 
        otherwise.
            ``(2) Manner of publication.--
                    ``(A) In general.--Rate and payment information 
                required to be made available under subsection (a)(9) 
                shall be so made available in dollar amounts through 3 
                separate machine-readable files corresponding to the 
                information described in each of subparagraphs (A) 
                through (C) of paragraph (1) that meet such 
                requirements as specified by the Secretary not later 
                than 180 days after the date of the enactment of this 
                paragraph through rulemaking. Such requirements shall 
                ensure that such files are limited to an appropriate 
                size, do not include information that is duplicative of 
                information contained in other files made available 
                under such subsection, are made available in a widely-
                available format that allows for information contained 
                in such files to be compared across group health plans 
                and group or individual health insurance coverage, and 
                are accessible to individuals at no cost and without 
                the need to establish a user account or provide other 
                credentials.
                    ``(B) Real-time provision of information.--
                            ``(i) In general.--Subject to clause (ii), 
                        beginning January 1, 2026, rate and payment 
                        information required to be made available by a 
                        group health plan or health insurance issuer 
                        under subsection (a)(9) shall, in addition to 
                        being made available in the manner described in 
                        subparagraph (A), be made available through an 
                        application program interface (or successor 
                        technology) that provides access to such 
                        information in real time and that meets such 
                        technical standards as may be specified by the 
                        Secretary.
                            ``(ii) Exemption for certain plans and 
                        coverage.--Clause (i) shall not apply with 
                        respect to information described in such clause 
                        required to be made available by a group health 
                        plan or health insurance issuer offering health 
                        insurance coverage if such plan or coverage, as 
                        applicable, provides benefits for fewer than 
                        500 enrollees.
            ``(3) User guide.--The Secretary, Secretary of Labor, and 
        Secretary of the Treasury shall jointly make available to the 
        public instructions written in plain language explaining how 
        individuals may search for information described in paragraph 
        (1) in files submitted in accordance with paragraph (2).
            ``(4) Annual summary.--For each year (beginning with 2025), 
        each group health plan and health insurance issuer offering 
        group or individual health insurance coverage shall make public 
        a machine-readable file meeting such standards as established 
        by the Secretary under paragraph (2) containing a summary of 
        all rate and payment information made public by such plan or 
        issuer with respect to such plan or coverage during such year 
        (such as averages of all such information so made public).
    ``(e) Attestation.--Each group health plan and health insurance 
issuer offering group or individual health insurance coverage shall 
annually submit to the Secretary an attestation of such plan's or such 
coverage's compliance with the provisions of this section along with a 
link to disclosures made in accordance with subsection (a).
    ``(f) Definitions.--In this subsection:
            ``(1) Participating provider.--The term `participating 
        provider' has the meaning given such term in section 2799A-1 
        and includes a participating facility.
            ``(2) In-network rate.--The term `in-network rate' means, 
        with respect to a group health plan or group or individual 
        health insurance coverage and an item or service furnished by a 
        provider that is a participating provider with respect to such 
        plan or coverage and item or service, the contracted rate 
        (reflected as a dollar amount) in effect between such plan or 
        coverage and such provider for such item or service.''.
    (b) Reports to Congress.--
            (1) Quality report.--Not later than 1 year after the date 
        of enactment of this subsection, the Secretary of Labor shall 
        submit to Congress a report on the feasibility of including 
        data relating to the quality of health care items and services 
        with the price transparency information required to be made 
        available under the amendments made by subsection (a). Such 
        report shall include recommendations for legislative and 
        regulatory actions to identify appropriate metrics for 
        assessing and comparing quality of care.
            (2) Transparency data assessment.--Not later than January 
        1, 2026, and biannually thereafter through 2032, the Secretary 
        shall submit to Congress, and make publicly available on a 
        website of the Department of Labor, a report with respect to 
        the information described in section 719 of the Employee 
        Retirement Income Security Act (29 U.S.C. 1185h) (as amended by 
        the ``Transparency in Coverage Act of 2023''), assessing the 
        differences in commercial negotiated prices--
                    (A) between rural and urban markets;
                    (B) in the individual, small-employer, and large-
                employer markets;
                    (C) in consolidated and non-consolidated provider 
                markets;
                    (D) between non-profit and for-profit hospitals; 
                and
                    (E) between non-profit and for-profit insurers.
    (c) Effective Date.--
            (1) In general.--The amendments made by subsection (a) 
        shall apply to plan years beginning on or after January 1, 
        2025.
            (2) Continued applicability of rules for previous years.--
        Nothing in the amendments made by subsection (a) may be 
        construed as affecting the applicability of the rule entitled 
        ``Transparency in Coverage'' published by the Department of the 
        Treasury, the Department of Labor, and the Department of Health 
        and Human Services on November 12, 2020 (85 Fed. Reg. 72158) 
        for plan years beginning before January 1, 2025.

SEC. 3. PHARMACY BENEFIT MANAGER TRANSPARENCY.

    (a) ERISA.--
            (1) In general.--Subtitle B of title I of the Employee 
        Retirement Income Security Act of 1974 (29 U.S.C. 1021 et seq.) 
        is amended--
                    (A) in subpart B of part 7 (29 U.S.C. 1185 et 
                seq.), by adding at the end the following:

``SEC. 726. OVERSIGHT OF PHARMACY BENEFITS MANAGER SERVICES.

    ``(a) In General.--For plan years beginning on or after January 1, 
2025, a group health plan (or health insurance issuer offering group 
health insurance coverage in connection with such a plan) or an entity 
or subsidiary providing pharmacy benefits management services on behalf 
of such a plan or issuer may not enter into a contract with a drug 
manufacturer, distributor, wholesaler, switch, patient or copay 
assistance program administrator, pharmacy, subcontractor, rebate 
aggregator, or any associated third party that limits or delays the 
disclosure of information to plan administrators in such a manner that 
prevents the plan or issuer, or an entity or subsidiary providing 
pharmacy benefits management services on behalf of a plan or issuer, 
from making or substantiating the reports described in subsection (b).
    ``(b) Reports.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2025, not less frequently than quarterly (and upon 
        request by the plan administrator), a group health plan or 
        health insurance issuer offering group health insurance 
        coverage, or an entity providing pharmacy benefits management 
        services on behalf of a group health plan or an issuer 
        providing group health insurance coverage, shall submit to the 
        plan administrator (as defined in section 3(16)(A)) of such 
        plan or coverage a report in accordance with this subsection, 
        and make such report available to the plan administrator in a 
        machine-readable format (or as may be determined by the 
        Secretary, other formats). Each such report shall include, with 
        respect to the applicable group health plan or health insurance 
        coverage--
                    ``(A) information collected from a patient or copay 
                assistance program administrator by such entity on the 
                total amount of copayment assistance dollars paid, or 
                copayment cards applied, or other discounts that were 
                funded by the drug manufacturer with respect to the 
                participants and beneficiaries in such plan or 
                coverage;
                    ``(B) total gross spending on prescription drugs by 
                the plan or coverage during the reporting period;
                    ``(C) total amount received, or expected to be 
                received, by the plan or coverage from any entities, in 
                rebates, fees, alternative discounts, and all other 
                remuneration received from the entity or any third 
                party (including group purchasing organizations) other 
                than the plan administrator, related to utilization of 
                drug or drug spending under such plan or coverage 
                during the reporting period;
                    ``(D) the total net spending on prescription drugs 
                by the plan or coverage during such reporting period;
                    ``(E) amounts paid, directly or indirectly, in 
                rebates, fees, or any other type of compensation (as 
                defined in section 408(b)(2)(B)(ii)(dd)(AA)) to 
                brokerage houses, brokers, consultants, advisors, or 
                any other individual or firm for the referral of the 
                group health plan's or health insurance issuer's 
                business to the pharmacy benefits manager, identified 
                by the recipient of such amounts;
                    ``(F)(i) an explanation of any benefit design 
                parameters that encourage or require participants and 
                beneficiaries in the plan or coverage to fill 
                prescriptions at mail order, specialty, or retail 
                pharmacies that are affiliated with or under common 
                ownership with the entity providing pharmacy benefit 
                management services under such plan or coverage, 
                including mandatory mail and specialty home delivery 
                programs, retail and mail auto-refill programs, and 
                cost-sharing assistance incentives funded by an entity 
                providing pharmacy benefit management services;
                            ``(ii) the percentage of total 
                        prescriptions charged to the plan, issuer, or 
                        participants and beneficiaries in such plan or 
                        coverage, that were dispensed by mail order, 
                        specialty, or retail pharmacies that are 
                        affiliated with or under common ownership with 
                        the entity providing pharmacy benefit 
                        management services; and
                            ``(iii) a list of all drugs dispensed by 
                        such affiliated pharmacy or pharmacy under 
                        common ownership and charged to the plan, 
                        issuer, or participants and beneficiaries of 
                        the plan, during the applicable period, and, 
                        with respect to each drug--
                                    ``(I)(aa) the amount charged, per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, with respect to 
                                participants and beneficiaries in the 
                                plan or coverage, to the plan or 
                                issuer; and
                                            ``(bb) the amount charged, 
                                        per dosage unit, per 30-day 
                                        supply, and per 90-day supply, 
                                        to participants and 
                                        beneficiaries;
                                    ``(II) the median amount charged to 
                                the plan or issuer, per dosage unit, 
                                per 30-day supply, and per 90-day 
                                supply, including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of such plan or 
                                coverage;
                                    ``(III) the interquartile range of 
                                the costs, per dosage unit, per 30-day 
                                supply, and per 90-day supply, 
                                including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of that plan or 
                                coverage;
                                    ``(IV) the lowest cost, per dosage 
                                unit, per 30-day supply, and per 90-day 
                                supply, for such drug, including 
                                amounts charged to the plan and 
                                participants and beneficiaries, that is 
                                available from any pharmacy included in 
                                the network of the plan or coverage;
                                    ``(V) the net acquisition cost per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, if the drug is subject 
                                to a maximum price discount; and
                                    ``(VI) other information with 
                                respect to the cost of the drug, as 
                                determined by the Secretary, such as 
                                average sales price, wholesale 
                                acquisition cost, and national average 
                                drug acquisition cost per dosage unit 
                                or per 30-day supply, and per 90-day 
                                supply, for such drug, including 
                                amounts charged to the plan or issuer 
                                and participants and beneficiaries 
                                among all pharmacies included in the 
                                network of such plan or coverage; and
                    ``(G) in the case of a large employer--
                            ``(i) a list of each drug covered by such 
                        plan, issuer, or entity providing pharmacy 
                        benefits management services for which a claim 
                        was filed during the reporting period, 
                        including, with respect to each such drug 
                        during the reporting period--
                                    ``(I) the brand name, generic or 
                                non-proprietary name, and the National 
                                Drug Code;
                                    ``(II)(aa) the number of 
                                participants and beneficiaries for whom 
                                a claim for such drug was filed during 
                                the reporting period, the total number 
                                of prescription claims for such drug 
                                (including original prescriptions and 
                                refills), and the total number of 
                                dosage units and total days supply of 
                                such drug for which a claim was filed 
                                during the reporting period; and
                                            ``(bb) with respect to each 
                                        claim or dosage unit described 
                                        in item (aa), the type of 
                                        dispensing channel used, such 
                                        as retail, mail order, or 
                                        specialty pharmacy;
                                    ``(III) the wholesale acquisition 
                                cost, listed as cost per days supply 
                                and cost per dosage unit on date of 
                                dispensing;
                                    ``(IV) the total out-of-pocket 
                                spending by participants and 
                                beneficiaries on such drug after 
                                application of any benefits under such 
                                plan or coverage, including participant 
                                and beneficiary spending through 
                                copayments, coinsurance, and 
                                deductibles (but not including any 
                                amounts spent by participants and 
                                beneficiaries on drugs not covered 
                                under such plan or coverage, or for 
                                which no claim was submitted to such 
                                plan or coverage);
                                    ``(V) for any drug for which gross 
                                spending of the plan or coverage 
                                exceeded $10,000 during the reporting 
                                period--
                                            ``(aa) a list of all other 
                                        drugs in the same therapeutic 
                                        category or class, including 
                                        brand name drugs, biological 
                                        products, generic drugs, or 
                                        biosimilar biological products 
                                        that are in the same 
                                        therapeutic category or class 
                                        as such drug; and
                                            ``(bb) the rationale for 
                                        preferred formulary placement 
                                        of such drug in that 
                                        therapeutic category or class, 
                                        if applicable; and
                            ``(ii) a list of each therapeutic category 
                        or class of drugs for which a claim was filed 
                        under the health plan or health insurance 
                        coverage during the reporting period, and, with 
                        respect to each such therapeutic category or 
                        class of drugs during the reporting period--
                                    ``(I) total gross spending by the 
                                plan;
                                    ``(II) the number of participants 
                                and beneficiaries who filled a 
                                prescription for a drug in that 
                                category or class;
                                    ``(III) if applicable to that 
                                category or class, a description of the 
                                formulary tiers and utilization 
                                mechanisms (such as prior authorization 
                                or step therapy) employed for drugs in 
                                that category or class;
                                    ``(IV) the total out-of-pocket 
                                spending by participants and 
                                beneficiaries, including participant 
                                and beneficiary spending through 
                                copayments, coinsurance, and 
                                deductibles; and
                                    ``(V) for each drug--
                                            ``(aa) the amount received, 
                                        or expected to be received, 
                                        from any entity in rebates, 
                                        fees, alternative discounts, or 
                                        other remuneration--

                                                    ``(AA) for claims 
                                                incurred during the 
                                                reporting period; or

                                                    ``(BB) that is 
                                                related to utilization 
                                                of drugs or drug 
                                                spending;

                                            ``(bb) the total net 
                                        spending, after deducting 
                                        rebates, price concessions, 
                                        alternative discounts or other 
                                        remuneration from drug 
                                        manufacturers, by the health 
                                        plan or health insurance 
                                        coverage on that category or 
                                        class of drugs; and
                                            ``(cc) the average net 
                                        spending per 30-day supply and 
                                        per 90-day supply, incurred by 
                                        the health plan or health 
                                        insurance coverage and its 
                                        participants and beneficiaries, 
                                        among all drugs within the 
                                        therapeutic class for which a 
                                        claim was filed during the 
                                        reporting period.
            ``(2) Privacy requirements.--Health insurance issuers 
        offering group health insurance coverage and entities providing 
        pharmacy benefits management services on behalf of a group 
        health plan shall provide information under paragraph (1) in a 
        manner consistent with the privacy, security, and breach 
        notification regulations promulgated under section 264(c) of 
        the Health Insurance Portability and Accountability Act of 
        1996, and shall restrict the use and disclosure of such 
        information according to such privacy regulations.
            ``(3) Disclosure and redisclosure.--
                    ``(A) Limitation to business associates.--A group 
                health plan receiving a report under paragraph (1) may 
                disclose such information only to business associates 
                of such plan as defined in section 160.103 of title 45, 
                Code of Federal Regulations (or successor regulations).
                    ``(B) Clarification regarding public disclosure of 
                information.--Nothing in this section prevents a health 
                insurance issuer offering group health insurance 
                coverage or an entity providing pharmacy benefits 
                management services on behalf of a group health plan 
                from placing reasonable restrictions on the public 
                disclosure of the information contained in a report 
                described in paragraph (1), except that such entity may 
                not restrict disclosure of such report to the 
                Department of Health and Human Services, the Department 
                of Labor, the Department of the Treasury, the 
                Comptroller General of the United States, or applicable 
                State agencies.
                    ``(C) Limited form of report.--The Secretary shall 
                define through rulemaking a limited form of the report 
                under paragraph (1) required of plan administrators who 
                are drug manufacturers, drug wholesalers, or other 
                direct participants in the drug supply chain, in order 
                to prevent anti-competitive behavior.
            ``(4) Report to gao.--A health insurance issuer offering 
        group health insurance coverage or an entity providing pharmacy 
        benefits management services on behalf of a group health plan 
        shall submit to the Comptroller General of the United States 
        each of the first 4 reports submitted to a plan administrator 
        under paragraph (1) with respect to such coverage or plan, and 
        other such reports as requested, in accordance with the privacy 
        requirements under paragraph (2), the disclosure and 
        redisclosure standards under paragraph (3), the standards 
        specified pursuant to paragraph (5).
            ``(5) Standard format.--Not later than 6 months after the 
        date of enactment of this section, the Secretary shall specify 
        through rulemaking standards for health insurance issuers and 
        entities required to submit reports under paragraph (4) to 
        submit such reports in a standard format.
    ``(c) Rule of Construction.--Nothing in this section shall be 
construed to permit a health insurance issuer, group health plan, or 
other entity to restrict disclosure to, or otherwise limit the access 
of, the Department of Labor to a report described in subsection (b)(1) 
or information related to compliance with subsection (a) by such 
issuer, plan, or entity.
    ``(d) Definitions.--In this section:
            ``(1) Large employer.--The term `large employer' means, in 
        connection with a group health plan with respect to a calendar 
        year and a plan year, an employer who employed an average of at 
        least 50 employees on business days during the preceding 
        calendar year and who employs at least 1 employee on the first 
        day of the plan year.
            ``(2) Wholesale acquisition cost.--The term `wholesale 
        acquisition cost' has the meaning given such term in section 
        1847A(c)(6)(B) of the Social Security Act.''; and
                    (B) in section 502 (29 U.S.C. 1132)--
                            (i) in subsection (a)--
                                    (I) in paragraph (6), by striking 
                                ``or (9)'' and inserting ``(9), or 
                                (13)'';
                                    (II) in paragraph (10), by striking 
                                at the end ``or'';
                                    (III) in paragraph (11), at the end 
                                by striking the period and inserting 
                                ``; or''; and
                                    (IV) by adding at the end the 
                                following new paragraph:
            ``(12) by the Secretary, to enforce section 726.'';
                            (ii) in subsection (b)(3), by inserting 
                        ``and subsections (a)(12) and (c)(13)'' before 
                        ``, the Secretary is not''; and
                            (iii) in subsection (c), by adding at the 
                        end the following new paragraph:
            ``(13) Secretarial enforcement authority relating to 
        oversight of pharmacy benefits manager services.--
                    ``(A) Failure to provide timely information.--The 
                Secretary may impose a penalty against any health 
                insurance issuer or entity providing pharmacy benefits 
                management services that violates section 726(a) or 
                fails to provide information required under section 
                726(b) in the amount of $10,000 for each day during 
                which such violation continues or such information is 
                not disclosed or reported.
                    ``(B) False information.--The Secretary may impose 
                a penalty against a health insurance issuer or entity 
                providing pharmacy benefits management services that 
                knowingly provides false information under section 726 
                in an amount not to exceed $100,000 for each item of 
                false information. Such penalty shall be in addition to 
                other penalties as may be prescribed by law.
                    ``(C) Waivers.--The Secretary may waive penalties 
                under subparagraph (A), or extend the period of time 
                for compliance with a requirement of section 726, for 
                an entity in violation of such section that has made a 
                good-faith effort to comply with such section.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1001 et seq.) is amended by inserting after the item 
        relating to section 725 the following new item:

``Sec. 726. Oversight of pharmacy benefits manager services.''.
    (b) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799A-11. OVERSIGHT OF PHARMACY BENEFITS MANAGER SERVICES.

    ``(a) In General.--For plan years beginning on or after January 1, 
2025, a group health plan (or health insurance issuer offering group 
health insurance coverage in connection with such a plan) or an entity 
or subsidiary providing pharmacy benefits management services on behalf 
of such a plan or issuer may not enter into a contract with a drug 
manufacturer, distributor, wholesaler, switch, patient or copay 
assistance program administrator, pharmacy, subcontractor, rebate 
aggregator, or any associated third party that limits or delays the 
disclosure of information to plan administrators in such a manner that 
prevents the plan or issuer, or an entity or subsidiary providing 
pharmacy benefits management services on behalf of a plan or issuer, 
from making or substantiating the reports described in subsection (b).
    ``(b) Reports.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2025, not less frequently than quarterly (and upon 
        request by the plan administrator), a group health plan or 
        health insurance issuer offering group health insurance 
        coverage, or an entity providing pharmacy benefits management 
        services on behalf of a group health plan or an issuer 
        providing group health insurance coverage, shall submit to the 
        plan administrator (as defined in section 3(16)(A) of the 
        Employee Retirement Income Security Act of 1974) of such plan 
        or coverage a report in accordance with this subsection, and 
        make such report available to the plan administrator in a 
        machine-readable format (or as may be determined by the 
        Secretary, other formats). Each such report shall include, with 
        respect to the applicable group health plan or health insurance 
        coverage--
                    ``(A) information collected from a patient or copay 
                assistance program administrator by such entity on the 
                total amount of copayment assistance dollars paid, or 
                copayment cards applied, or other discounts that were 
                funded by the drug manufacturer with respect to the 
                participants and beneficiaries in such plan or 
                coverage;
                    ``(B) total gross spending on prescription drugs by 
                the plan or coverage during the reporting period;
                    ``(C) total amount received, or expected to be 
                received, by the plan or coverage from any entities, in 
                rebates, fees, alternative discounts, and all other 
                remuneration received from the entity or any third 
                party (including group purchasing organizations) other 
                than the plan administrator, related to utilization of 
                drug or drug spending under such plan or coverage 
                during the reporting period;
                    ``(D) the total net spending on prescription drugs 
                by the plan or coverage during such reporting period;
                    ``(E) amounts paid, directly or indirectly, in 
                rebates, fees, or any other type of compensation (as 
                defined in section 408(b)(2)(B)(ii)(dd)(AA) of the 
                Employee Retirement Income Security Act of 1974) to 
                brokerage houses, brokers, consultants, advisors, or 
                any other individual or firm for the referral of the 
                group health plan's or health insurance issuer's 
                business to the pharmacy benefits manager, identified 
                by the recipient of such amounts;
                    ``(F)(i) an explanation of any benefit design 
                parameters that encourage or require participants and 
                beneficiaries in the plan or coverage to fill 
                prescriptions at mail order, specialty, or retail 
                pharmacies that are affiliated with or under common 
                ownership with the entity providing pharmacy benefit 
                management services under such plan or coverage, 
                including mandatory mail and specialty home delivery 
                programs, retail and mail auto-refill programs, and 
                cost-sharing assistance incentives funded by an entity 
                providing pharmacy benefit management services;
                            ``(ii) the percentage of total 
                        prescriptions charged to the plan, issuer, or 
                        participants and beneficiaries in such plan or 
                        coverage, that were dispensed by mail order, 
                        specialty, or retail pharmacies that are 
                        affiliated with or under common ownership with 
                        the entity providing pharmacy benefit 
                        management services; and
                            ``(iii) a list of all drugs dispensed by 
                        such affiliated pharmacy or pharmacy under 
                        common ownership and charged to the plan, 
                        issuer, or participants and beneficiaries of 
                        the plan, during the applicable period, and, 
                        with respect to each drug--
                                    ``(I)(aa) the amount charged, per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, with respect to 
                                participants and beneficiaries in the 
                                plan or coverage, to the plan or 
                                issuer; and
                                            ``(bb) the amount charged, 
                                        per dosage unit, per 30-day 
                                        supply, and per 90-day supply, 
                                        to participants and 
                                        beneficiaries;
                                    ``(II) the median amount charged to 
                                the plan or issuer, per dosage unit, 
                                per 30-day supply, and per 90-day 
                                supply, including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of such plan or 
                                coverage;
                                    ``(III) the interquartile range of 
                                the costs, per dosage unit, per 30-day 
                                supply, and per 90-day supply, 
                                including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of that plan or 
                                coverage;
                                    ``(IV) the lowest cost, per dosage 
                                unit, per 30-day supply, and per 90-day 
                                supply, for such drug, including 
                                amounts charged to the plan and 
                                participants and beneficiaries, that is 
                                available from any pharmacy included in 
                                the network of the plan or coverage;
                                    ``(V) the net acquisition cost per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, if the drug is subject 
                                to a maximum price discount; and
                                    ``(VI) other information with 
                                respect to the cost of the drug, as 
                                determined by the Secretary, such as 
                                average sales price, wholesale 
                                acquisition cost, and national average 
                                drug acquisition cost per dosage unit 
                                or per 30-day supply, and per 90-day 
                                supply, for such drug, including 
                                amounts charged to the plan or issuer 
                                and participants and beneficiaries 
                                among all pharmacies included in the 
                                network of such plan or coverage; and
                    ``(G) in the case of a large employer--
                            ``(i) a list of each drug covered by such 
                        plan, issuer, or entity providing pharmacy 
                        benefits management services for which a claim 
                        was filed during the reporting period, 
                        including, with respect to each such drug 
                        during the reporting period--
                                    ``(I) the brand name, generic or 
                                non-proprietary name, and the National 
                                Drug Code;
                                    ``(II)(aa) the number of 
                                participants and beneficiaries for whom 
                                a claim for such drug was filed during 
                                the reporting period, the total number 
                                of prescription claims for such drug 
                                (including original prescriptions and 
                                refills), and the total number of 
                                dosage units and total days supply of 
                                such drug for which a claim was filed 
                                during the reporting period; and
                                            ``(bb) with respect to each 
                                        claim or dosage unit described 
                                        in item (aa), the type of 
                                        dispensing channel used, such 
                                        as retail, mail order, or 
                                        specialty pharmacy;
                                    ``(III) the wholesale acquisition 
                                cost, listed as cost per days supply 
                                and cost per dosage unit on date of 
                                dispensing;
                                    ``(IV) the total out-of-pocket 
                                spending by participants and 
                                beneficiaries on such drug after 
                                application of any benefits under such 
                                plan or coverage, including participant 
                                and beneficiary spending through 
                                copayments, coinsurance, and 
                                deductibles (but not including any 
                                amounts spent by participants and 
                                beneficiaries on drugs not covered 
                                under such plan or coverage, or for 
                                which no claim was submitted to such 
                                plan or coverage);
                                    ``(V) for any drug for which gross 
                                spending of the plan or coverage 
                                exceeded $10,000 during the reporting 
                                period--
                                            ``(aa) a list of all other 
                                        drugs in the same therapeutic 
                                        category or class, including 
                                        brand name drugs, biological 
                                        products, generic drugs, or 
                                        biosimilar biological products 
                                        that are in the same 
                                        therapeutic category or class 
                                        as such drug; and
                                            ``(bb) the rationale for 
                                        preferred formulary placement 
                                        of such drug in that 
                                        therapeutic category or class, 
                                        if applicable; and
                            ``(ii) a list of each therapeutic category 
                        or class of drugs for which a claim was filed 
                        under the health plan or health insurance 
                        coverage during the reporting period, and, with 
                        respect to each such therapeutic category or 
                        class of drugs during the reporting period--
                                    ``(I) total gross spending by the 
                                plan;
                                    ``(II) the number of participants 
                                and beneficiaries who filled a 
                                prescription for a drug in that 
                                category or class;
                                    ``(III) if applicable to that 
                                category or class, a description of the 
                                formulary tiers and utilization 
                                mechanisms (such as prior authorization 
                                or step therapy) employed for drugs in 
                                that category or class;
                                    ``(IV) the total out-of-pocket 
                                spending by participants and 
                                beneficiaries, including participant 
                                and beneficiary spending through 
                                copayments, coinsurance, and 
                                deductibles; and
                                    ``(V) for each drug--
                                            ``(aa) the amount received, 
                                        or expected to be received, 
                                        from any entity in rebates, 
                                        fees, alternative discounts, or 
                                        other remuneration--

                                                    ``(AA) for claims 
                                                incurred during the 
                                                reporting period; or

                                                    ``(BB) that is 
                                                related to utilization 
                                                of drugs or drug 
                                                spending;

                                            ``(bb) the total net 
                                        spending, after deducting 
                                        rebates, price concessions, 
                                        alternative discounts or other 
                                        remuneration from drug 
                                        manufacturers, by the health 
                                        plan or health insurance 
                                        coverage on that category or 
                                        class of drugs; and
                                            ``(cc) the average net 
                                        spending per 30-day supply and 
                                        per 90-day supply, incurred by 
                                        the health plan or health 
                                        insurance coverage and its 
                                        participants and beneficiaries, 
                                        among all drugs within the 
                                        therapeutic class for which a 
                                        claim was filed during the 
                                        reporting period.
            ``(2) Privacy requirements.--Health insurance issuers 
        offering group health insurance coverage and entities providing 
        pharmacy benefits management services on behalf of a group 
        health plan shall provide information under paragraph (1) in a 
        manner consistent with the privacy, security, and breach 
        notification regulations promulgated under section 264(c) of 
        the Health Insurance Portability and Accountability Act of 
        1996, and shall restrict the use and disclosure of such 
        information according to such privacy regulations.
            ``(3) Disclosure and redisclosure.--
                    ``(A) Limitation to business associates.--A group 
                health plan receiving a report under paragraph (1) may 
                disclose such information only to business associates 
                of such plan as defined in section 160.103 of title 45, 
                Code of Federal Regulations (or successor regulations).
                    ``(B) Clarification regarding public disclosure of 
                information.--Nothing in this section prevents a health 
                insurance issuer offering group health insurance 
                coverage or an entity providing pharmacy benefits 
                management services on behalf of a group health plan 
                from placing reasonable restrictions on the public 
                disclosure of the information contained in a report 
                described in paragraph (1), except that such issuer or 
                entity may not restrict disclosure of such report to 
                the Department of Health and Human Services, the 
                Department of Labor, the Department of the Treasury, 
                the Comptroller General of the United States, or 
                applicable State agencies.
                    ``(C) Limited form of report.--The Secretary shall 
                define through rulemaking a limited form of the report 
                under paragraph (1) required of plan administrators who 
                are drug manufacturers, drug wholesalers, or other 
                direct participants in the drug supply chain, in order 
                to prevent anti-competitive behavior.
            ``(4) Report to gao.--A health insurance issuer offering 
        group health insurance coverage or an entity providing pharmacy 
        benefits management services on behalf of a group health plan 
        shall submit to the Comptroller General of the United States 
        each of the first 4 reports submitted to a plan administrator 
        under paragraph (1) with respect to such coverage or plan, and 
        other such reports as requested, in accordance with the privacy 
        requirements under paragraph (2), the disclosure and 
        redisclosure standards under paragraph (3), the standards 
        specified pursuant to paragraph (5).
            ``(5) Standard format.--Not later than 6 months after the 
        date of enactment of this section, the Secretary shall specify 
        through rulemaking standards for health insurance issuers and 
        entities required to submit reports under paragraph (4) to 
        submit such reports in a standard format.
    ``(c) Enforcement.--
            ``(1) Failure to provide timely information.--An entity 
        providing pharmacy benefits management services that violates 
        subsection (a) or fails to provide information required under 
        subsection (b) shall be subject to a civil monetary penalty in 
        the amount of $10,000 for each day during which such violation 
        continues or such information is not disclosed or reported.
            ``(2) False information.--An entity providing pharmacy 
        benefits management services that knowingly provides false 
        information under this section shall be subject to a civil 
        money penalty in an amount not to exceed $100,000 for each item 
        of false information. Such civil money penalty shall be in 
        addition to other penalties as may be prescribed by law.
            ``(3) Procedure.--The provisions of section 1128A of the 
        Social Security Act, other than subsection (a) and (b) and the 
        first sentence of subsection (c)(1) of such section shall apply 
        to civil monetary penalties under this subsection in the same 
        manner as such provisions apply to a penalty or proceeding 
        under section 1128A of the Social Security Act.
            ``(4) Waivers.--The Secretary may waive penalties under 
        paragraph (2), or extend the period of time for compliance with 
        a requirement of this section, for an entity in violation of 
        this section that has made a good-faith effort to comply with 
        this section.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to permit a health insurance issuer, group health plan, or 
other entity to restrict disclosure to, or otherwise limit the access 
of, the Department of Health and Human Services to a report described 
in subsection (b)(1) or information related to compliance with 
subsection (a) by such issuer, plan, or entity.
    ``(e) Definitions.--In this section:
            ``(1) Large employer.--The term `large employer' means, in 
        connection with a group health plan with respect to a calendar 
        year and a plan year, an employer who employed an average of at 
        least 50 employees on business days during the preceding 
        calendar year and who employs at least 1 employee on the first 
        day of the plan year.
            ``(2) Wholesale acquisition cost.--The term `wholesale 
        acquisition cost' has the meaning given such term in section 
        1847A(c)(6)(B) of the Social Security Act.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9826. OVERSIGHT OF PHARMACY BENEFITS MANAGER SERVICES.

    ``(a) In General.--For plan years beginning on or after January 1, 
2025, a group health plan or an entity or subsidiary providing pharmacy 
benefits management services on behalf of such a plan may not enter 
into a contract with a drug manufacturer, distributor, wholesaler, 
switch, patient or copay assistance program administrator, pharmacy, 
subcontractor, rebate aggregator, or any associated third party that 
limits or delays the disclosure of information to plan administrators 
in such a manner that prevents the plan, or an entity or subsidiary 
providing pharmacy benefits management services on behalf of a plan, 
from making or substantiating the reports described in subsection (b).
    ``(b) Reports.--
            ``(1) In general.--For plan years beginning on or after 
        January 1, 2025, not less frequently than quarterly (and upon 
        request by the plan administrator), a group health plan, or an 
        entity providing pharmacy benefits management services on 
        behalf of a group health plan, shall submit to the plan 
        administrator (as defined in section 3(16)(A) of the Employee 
        Retirement Income Security Act of 1974) of such plan a report 
        in accordance with this subsection, and make such report 
        available to the plan administrator in a machine-readable 
        format (or as may be determined by the Secretary, other 
        formats). Each such report shall include, with respect to the 
        applicable group health plan--
                    ``(A) information collected from a patient or copay 
                assistance program administrator by such entity on the 
                total amount of copayment assistance dollars paid, or 
                copayment cards applied, or other discounts that were 
                funded by the drug manufacturer with respect to the 
                participants and beneficiaries in such plan;
                    ``(B) total gross spending on prescription drugs by 
                the plan during the reporting period;
                    ``(C) total amount received, or expected to be 
                received, by the plan from any entities, in rebates, 
                fees, alternative discounts, and all other remuneration 
                received from the entity or any third party (including 
                group purchasing organizations) other than the plan 
                administrator, related to utilization of drug or drug 
                spending under such plan during the reporting period;
                    ``(D) the total net spending on prescription drugs 
                by the plan during such reporting period;
                    ``(E) amounts paid, directly or indirectly, in 
                rebates, fees, or any other type of compensation (as 
                defined in section 408(b)(2)(B)(ii)(dd)(AA) of the 
                Employee Retirement Income Security Act of 1974) to 
                brokerage houses, brokers, consultants, advisors, or 
                any other individual or firm for the referral of the 
                group health plan's business to the pharmacy benefits 
                manager, identified by the recipient of such amounts;
                    ``(F)(i) an explanation of any benefit design 
                parameters that encourage or require participants and 
                beneficiaries in the plan to fill prescriptions at mail 
                order, specialty, or retail pharmacies that are 
                affiliated with or under common ownership with the 
                entity providing pharmacy benefit management services 
                under such plan, including mandatory mail and specialty 
                home delivery programs, retail and mail auto-refill 
                programs, and cost-sharing assistance incentives funded 
                by an entity providing pharmacy benefit management 
                services;
                            ``(ii) the percentage of total 
                        prescriptions charged to the plan, or 
                        participants and beneficiaries in such plan, 
                        that were dispensed by mail order, specialty, 
                        or retail pharmacies that are affiliated with 
                        or under common ownership with the entity 
                        providing pharmacy benefit management services; 
                        and
                            ``(iii) a list of all drugs dispensed by 
                        such affiliated pharmacy or pharmacy under 
                        common ownership and charged to the plan, or 
                        participants and beneficiaries of the plan, 
                        during the applicable period, and, with respect 
                        to each drug--
                                    ``(I)(aa) the amount charged, per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, with respect to 
                                participants and beneficiaries in the 
                                plan, to the plan; and
                                            ``(bb) the amount charged, 
                                        per dosage unit, per 30-day 
                                        supply, and per 90-day supply, 
                                        to participants and 
                                        beneficiaries;
                                    ``(II) the median amount charged to 
                                the plan, per dosage unit, per 30-day 
                                supply, and per 90-day supply, 
                                including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of such plan;
                                    ``(III) the interquartile range of 
                                the costs, per dosage unit, per 30-day 
                                supply, and per 90-day supply, 
                                including amounts paid by the 
                                participants and beneficiaries, when 
                                the same drug is dispensed by other 
                                pharmacies that are not affiliated with 
                                or under common ownership with the 
                                entity and that are included in the 
                                pharmacy network of that plan;
                                    ``(IV) the lowest cost, per dosage 
                                unit, per 30-day supply, and per 90-day 
                                supply, for such drug, including 
                                amounts charged to the plan and 
                                participants and beneficiaries, that is 
                                available from any pharmacy included in 
                                the network of the plan;
                                    ``(V) the net acquisition cost per 
                                dosage unit, per 30-day supply, and per 
                                90-day supply, if the drug is subject 
                                to a maximum price discount; and
                                    ``(VI) other information with 
                                respect to the cost of the drug, as 
                                determined by the Secretary, such as 
                                average sales price, wholesale 
                                acquisition cost, and national average 
                                drug acquisition cost per dosage unit 
                                or per 30-day supply, and per-90 day 
                                supply, for such drug, including 
                                amounts charged to the plan and 
                                participants and beneficiaries among 
                                all pharmacies included in the network 
                                of such plan; and
                    ``(G) in the case of a large employer--
                            ``(i) a list of each drug covered by such 
                        plan or entity providing pharmacy benefits 
                        management services for which a claim was filed 
                        during the reporting period, including, with 
                        respect to each such drug during the reporting 
                        period--
                                    ``(I) the brand name, generic or 
                                non-proprietary name, and the National 
                                Drug Code;
                                    ``(II)(aa) the number of 
                                participants and beneficiaries for whom 
                                a claim for such drug was filed during 
                                the reporting period, the total number 
                                of prescription claims for such drug 
                                (including original prescriptions and 
                                refills), and the total number of 
                                dosage units and total days supply of 
                                such drug for which a claim was filed 
                                during the reporting period; and
                                            ``(bb) with respect to each 
                                        claim or dosage unit described 
                                        in item (aa), the type of 
                                        dispensing channel used, such 
                                        as retail, mail order, or 
                                        specialty pharmacy;
                                    ``(III) the wholesale acquisition 
                                cost, listed as cost per days supply 
                                and cost per dosage unit on date of 
                                dispensing;
                                    ``(IV) the total out-of-pocket 
                                spending by participants and 
                                beneficiaries on such drug after 
                                application of any benefits under such 
                                plan, including participant and 
                                beneficiary spending through 
                                copayments, coinsurance, and 
                                deductibles (but not including any 
                                amounts spent by participants and 
                                beneficiaries on drugs not covered 
                                under such plan, or for which no claim 
                                was submitted to such plan);
                                    ``(V) for any drug for which gross 
                                spending of the plan exceeded $10,000 
                                during the reporting period--
                                            ``(aa) a list of all other 
                                        drugs in the same therapeutic 
                                        category or class, including 
                                        brand name drugs, biological 
                                        products, generic drugs, or 
                                        biosimilar biological products 
                                        that are in the same 
                                        therapeutic category or class 
                                        as such drug; and
                                            ``(bb) the rationale for 
                                        preferred formulary placement 
                                        of such drug in that 
                                        therapeutic category or class, 
                                        if applicable; and
                            ``(ii) a list of each therapeutic category 
                        or class of drugs for which a claim was filed 
                        under the plan during the reporting period, 
                        and, with respect to each such therapeutic 
                        category or class of drugs during the reporting 
                        period--
                                    ``(I) total gross spending by the 
                                plan;
                                    ``(II) the number of participants 
                                and beneficiaries who filled a 
                                prescription for a drug in that 
                                category or class;
                                    ``(III) if applicable to that 
                                category or class, a description of the 
                                formulary tiers and utilization 
                                mechanisms (such as prior authorization 
                                or step therapy) employed for drugs in 
                                that category or class;
                                    ``(IV) the total out-of-pocket 
                                spending by participants and 
                                beneficiaries, including participant 
                                and beneficiary spending through 
                                copayments, coinsurance, and 
                                deductibles; and
                                    ``(V) for each drug--
                                            ``(aa) the amount received, 
                                        or expected to be received, 
                                        from any entity in rebates, 
                                        fees, alternative discounts, or 
                                        other remuneration--

                                                    ``(AA) for claims 
                                                incurred during the 
                                                reporting period; or

                                                    ``(BB) that is 
                                                related to utilization 
                                                of drugs or drug 
                                                spending;

                                            ``(bb) the total net 
                                        spending, after deducting 
                                        rebates, price concessions, 
                                        alternative discounts or other 
                                        remuneration from drug 
                                        manufacturers, by the plan on 
                                        that category or class of 
                                        drugs; and
                                            ``(cc) the average net 
                                        spending per 30-day supply and 
                                        per 90-day supply, incurred by 
                                        the plan and its participants 
                                        and beneficiaries, among all 
                                        drugs within the therapeutic 
                                        class for which a claim was 
                                        filed during the reporting 
                                        period.
            ``(2) Privacy requirements.--Entities providing pharmacy 
        benefits management services on behalf of a group health plan 
        shall provide information under paragraph (1) in a manner 
        consistent with the privacy, security, and breach notification 
        regulations promulgated under section 264(c) of the Health 
        Insurance Portability and Accountability Act of 1996, and shall 
        restrict the use and disclosure of such information according 
        to such privacy regulations.
            ``(3) Disclosure and redisclosure.--
                    ``(A) Limitation to business associates.--A group 
                health plan receiving a report under paragraph (1) may 
                disclose such information only to business associates 
                of such plan as defined in section 160.103 of title 45, 
                Code of Federal Regulations (or successor regulations).
                    ``(B) Clarification regarding public disclosure of 
                information.--Nothing in this section prevents an 
                entity providing pharmacy benefits management services 
                on behalf of a group health plan from placing 
                reasonable restrictions on the public disclosure of the 
                information contained in a report described in 
                paragraph (1), except that such entity may not restrict 
                disclosure of such report to the Department of Health 
                and Human Services, the Department of Labor, the 
                Department of the Treasury, the Comptroller General of 
                the United States, or applicable State agencies.
                    ``(C) Limited form of report.--The Secretary shall 
                define through rulemaking a limited form of the report 
                under paragraph (1) required of plan administrators who 
                are drug manufacturers, drug wholesalers, or other 
                direct participants in the drug supply chain, in order 
                to prevent anti-competitive behavior.
            ``(4) Report to gao.--An entity providing pharmacy benefits 
        management services on behalf of a group health plan shall 
        submit to the Comptroller General of the United States each of 
        the first 4 reports submitted to a plan administrator under 
        paragraph (1) with respect to such plan, and other such reports 
        as requested, in accordance with the privacy requirements under 
        paragraph (2), the disclosure and redisclosure standards under 
        paragraph (3), the standards specified pursuant to paragraph 
        (5).
            ``(5) Standard format.--Not later than 6 months after the 
        date of enactment of this section, the Secretary shall specify 
        through rulemaking standards for entities required to submit 
        reports under paragraph (4) to submit such reports in a 
        standard format.
    ``(c) Enforcement.--
            ``(1) Failure to provide timely information.--An entity 
        providing pharmacy benefits management services that violates 
        subsection (a) or fails to provide information required under 
        subsection (b) shall be subject to a civil monetary penalty in 
        the amount of $10,000 for each day during which such violation 
        continues or such information is not disclosed or reported.
            ``(2) False information.--An entity providing pharmacy 
        benefits management services that knowingly provides false 
        information under this section shall be subject to a civil 
        money penalty in an amount not to exceed $100,000 for each item 
        of false information. Such civil money penalty shall be in 
        addition to other penalties as may be prescribed by law.
            ``(3) Procedure.--The provisions of section 1128A of the 
        Social Security Act, other than subsection (a) and (b) and the 
        first sentence of subsection (c)(1) of such section shall apply 
        to civil monetary penalties under this subsection in the same 
        manner as such provisions apply to a penalty or proceeding 
        under section 1128A of the Social Security Act.
            ``(4) Waivers.--The Secretary may waive penalties under 
        paragraph (2), or extend the period of time for compliance with 
        a requirement of this section, for an entity in violation of 
        this section that has made a good-faith effort to comply with 
        this section.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to permit a group health plan, or other entity to restrict 
disclosure to, or otherwise limit the access of, the Department of the 
Treasury to a report described in subsection (b)(1) or information 
related to compliance with subsection (a) by such plan or entity.
    ``(e) Definitions.--In this section:
            ``(1) Large employer.--The term `large employer' means, in 
        connection with a group health plan with respect to a calendar 
        year and a plan year, an employer who employed an average of at 
        least 50 employees on business days during the preceding 
        calendar year and who employs at least 1 employee on the first 
        day of the plan year.
            ``(2) Wholesale acquisition cost.--The term `wholesale 
        acquisition cost' has the meaning given such term in section 
        1847A(c)(6)(B) of the Social Security Act.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986 is amended by adding at the end the following new item:

``Sec. 9826. Oversight of pharmacy benefits manager services.''.

SEC. 4. INFORMATION ON PRESCRIPTION DRUGS.

    (a) 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.), as amended by section 3, is further amended by adding at the end 
the following new section:

``SEC. 727. INFORMATION ON PRESCRIPTION DRUGS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group health insurance coverage shall--
            ``(1) not restrict, directly or indirectly, any pharmacy 
        that dispenses a prescription drug to a participant of 
        beneficiary in the plan or coverage from informing (or penalize 
        such pharmacy for informing) a participant or beneficiary of 
        any differential between the participant's or beneficiary's 
        out-of-pocket cost under the plan or coverage with respect to 
        acquisition of the drug and the amount an individual would pay 
        for acquisition of the drug without using any health plan or 
        health insurance coverage; and
            ``(2) ensure that any entity that provides pharmacy 
        benefits management services under a contract with any such 
        health plan or health insurance coverage does not, with respect 
        to such plan or coverage, restrict, directly or indirectly, a 
        pharmacy that dispenses a prescription drug from informing (or 
        penalize such pharmacy for informing) a participant or 
        beneficiary of any differential between the participant's or 
        beneficiary's out-of-pocket cost under the plan or coverage 
        with respect to acquisition of the drug and the amount an 
        individual would pay for acquisition of the drug without using 
        any health plan or health insurance coverage.
    ``(b) Definition.--For purposes of this section, the term `out-of-
pocket cost', with respect to acquisition of a drug, means the amount 
to be paid by the participant or beneficiary under the plan or 
coverage, including any cost-sharing (including any deductible, 
copayment, or coinsurance) and, as determined by the Secretary, any 
other expenditure.''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et 
seq.), as amended by section 3, is further amended by inserting after 
the item relating to section 726 the following new item:

``Sec. 727. Information on prescription drugs.''.

SEC. 5. ADVISORY COMMITTEE ON THE ACCESSIBILITY OF CERTAIN INFORMATION.

    (a) In General.--Not later than January 1, 2025, the Secretary of 
Labor (in this section referred to as the ``Secretary'') shall convene 
an Advisory Committee (in this section referred to as the 
``Committee'') consisting of 9 members to advise the Secretary on how 
to improve the accessibility and usability of information made 
available in accordance the amendments made by section 3 and by section 
204 of division BB of the Consolidated Appropriation Act, 2021 (Public 
Law 116-260), streamline the reporting of such information, and ensure 
that such information fully meets the needs of employers, patients, 
researchers, regulators, and purchasers.
    (b) Membership.--The Secretary shall appoint members representing 
end-users of the information described in subsection (a). Vacancies on 
the Committee shall be filled by appointment consistent with this 
subsection not later than 3 months after the vacancy arises.
    (c) Termination.--The Committee established under this section 
shall terminate on January 1, 2028.
                                 <all>