[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4712 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 4712

 To provide for increased oversight of entities that provide pharmacy 
benefit management services on behalf of group health plans and health 
                          insurance coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 18, 2023

Mrs. Harshbarger (for herself and Ms. Manning) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Ways and Means, and Education and the 
 Workforce, 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 provide for increased oversight of entities that provide pharmacy 
benefit management services on behalf of group health plans and health 
                          insurance coverage.

    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 ``Patient Right to Shop Act''.

SEC. 2. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.

    (a) 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:

``SEC. 2799A-11. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT 
              TOOLS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage shall not enter 
into a contract with an entity that provides pharmacy benefit 
management services with respect to such plan or coverage if such 
contract includes any terms, conditions, or costs that would prevent or 
restrict a covered third party from accessing or using information, for 
purposes of the consumer decision-support tool, relevant to the 
operability, implementation, and utilization of the consumer-decision 
support tool regarding prescription drug benefits under the plan or 
coverage that are administered by the entity providing pharmacy benefit 
management services in contract with the plan or issuer.
    ``(b) Definitions.--In this section:
            ``(1) Consumer decision-support tool.--The term `consumer 
        decision-support tool' means a tool designed to inform 
        enrollees in a group health plan or health insurance coverage 
        about all costs to the enrollee for prescription drugs covered 
        by the plan or coverage, including out-of-pocket, copayment, 
        and coinsurance responsibility, as well as costs to the 
        enrollee, such as purchasing at the cash price or purchasing 
        through mail order pharmacy benefits.
            ``(2) Covered third party.--The term `covered third party' 
        means a third party that is in contract, as a business 
        associate (as defined in section 160.103 of title 45, Code of 
        Federal Regulations (or successor regulations)), with a group 
        health plan or a health insurance issuer offering group or 
        individual health insurance coverage to provide a consumer 
        decision-support tool.
    ``(c) Rules of Construction Regarding Privacy.--
            ``(1) Nothing in this section shall be construed to alter 
        existing obligations of a covered entity or business associate 
        under the privacy, security, and breach notification 
        regulations in parts 160 and 164 of title 45, Code of Federal 
        Regulations (or successor regulations).
            ``(2) Nothing in this section shall be construed to require 
        a group health plan, a health insurance issuer offering group 
        or individual health insurance coverage, or an entity providing 
        pharmacy benefit management services to share protected health 
        information, as defined in section 160.103 of title 45, Code of 
        Federal Regulations (or successor regulations), with a covered 
        third party.''.
    (b) ERISA.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185 et seq.) is amended by adding at the end the 
        following new section:

``SEC. 726. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group health insurance coverage shall not enter into a 
contract with an entity that provides pharmacy benefit management 
services with respect to such plan or coverage if such contract 
includes any terms, conditions, or costs that would prevent or restrict 
a covered third party from accessing or using information, for purposes 
of the consumer decision-support tool, relevant to the operability, 
implementation, and utilization of the consumer-decision support tool 
regarding prescription drug benefits under the plan or coverage that 
are administered by the entity providing pharmacy benefit management 
services in contract with the plan or issuer.
    ``(b) Definitions.--In this section:
            ``(1) Consumer decision-support tool.--The term `consumer 
        decision-support tool' means a tool designed to inform 
        participants and beneficiaries in a group health plan or health 
        insurance coverage about all costs to the participant or 
        beneficiary for prescription drugs covered by the plan or 
        coverage, including out-of-pocket, copayment, and coinsurance 
        responsibility, as well as costs to the participant or 
        beneficiary, such as purchasing at the cash price or purchasing 
        through mail order pharmacy benefits.
            ``(2) Covered third party.--The term `covered third party' 
        means a third party that is in contract, as a business 
        associate (as defined in section 160.103 of title 45, Code of 
        Federal Regulations (or successor regulations)), with a group 
        health plan or a health insurance issuer offering group health 
        insurance coverage to provide a consumer decision-support tool.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to alter 
        existing obligations of a covered entity or business associate 
        under the privacy, security, and breach notification 
        regulations in parts 160 and 164 of title 45, Code of Federal 
        Regulations (or successor regulations).
            ``(2) Nothing in this section shall be construed to require 
        a group health plan, a health insurance issuer offering group 
        health insurance coverage, or an entity providing pharmacy 
        benefit management services to share protected health 
        information, as defined in section 160.103 of title 45, Code of 
        Federal Regulations (or successor regulations), with a covered 
        third party.''.
            (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:

``Sec. 726. Prohibition on blocking consumer decision-support tools.''.
    (c) Internal Revenue Code.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986, as amended by section 2, is 
        further amended by adding at the end the following new section:

``SEC. 9826. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.

    ``(a) In General.--A group health plan offering group health 
insurance coverage shall not enter into a contract with an entity that 
provides pharmacy benefit management services with respect to such plan 
if such contract includes any terms, conditions, or costs that would 
prevent or restrict a covered third party from accessing or using 
information, for purposes of the consumer decision-support tool, 
relevant to the operability, implementation, and utilization of the 
consumer-decision support tool regarding prescription drug benefits 
under the plan that are administered by the entity providing pharmacy 
benefit management services in contract with the plan.
    ``(b) Definitions.--In this section:
            ``(1) Consumer decision-support tool.--The term `consumer 
        decision-support tool' means a tool designed to inform 
        participants and beneficiaries in a group health plan about all 
        costs to the participant or beneficiary for prescription drugs 
        covered by the plan, including out-of-pocket, copayment, and 
        coinsurance responsibility, as well as costs to the participant 
        or beneficiary, such as purchasing at the cash price or 
        purchasing through mail order pharmacy benefits.
            ``(2) Covered third party.--The term `covered third party' 
        means a third party that is in contract, as a business 
        associate (as defined in section 160.103 of title 45, Code of 
        Federal Regulations (or successor regulations)), with a group 
        health plan or a health insurance issuer offering group health 
        insurance coverage to provide a consumer decision-support tool.
    ``(c) Rules of Construction.--
            ``(1) Nothing in this section shall be construed to alter 
        existing obligations of a covered entity or business associate 
        under the privacy, security, and breach notification 
        regulations in parts 160 and 164 of title 45, Code of Federal 
        Regulations (or successor regulations).
            ``(2) Nothing in this section shall be construed to require 
        a group health plan or an entity providing pharmacy benefit 
        management services to share protected health information, as 
        defined in section 160.103 of title 45, Code of Federal 
        Regulations (or successor regulations), with a covered third 
        party.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of such Code is amended by adding 
        at the end the following new item:

``Sec. 9826. Prohibition on blocking consumer decision-support 
                            tools.''.
    (d) Application.--The amendments made by subsections (a), (b), and 
(c) shall apply with respect to plan years beginning on or after the 
date that is 2 years after the date of enactment of this Act.
    (e) Regulations.--The Secretary of Health and Human Services, the 
Secretary of Labor, and the Secretary of the Treasury shall jointly 
promulgate regulations to carry out the amendments made by subsections 
(a), (b), and (c), and shall issue draft regulations not later than 1 
year after the date of enactment of this Act.
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