[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7717 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 7717

   To amend title XI of the Social Security Act to enhance pharmacy 
               benefit manager transparency requirements.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 19, 2024

 Mr. Gallego introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   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 title XI of the Social Security Act to enhance pharmacy 
               benefit manager transparency requirements.

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

SECTION 1. ENHANCING PBM TRANSPARENCY REQUIREMENTS.

    (a) In General.--Section 1150A of the Social Security Act (42 
U.S.C. 1320b-23) is amended--
            (1) by striking subsection (a) and inserting the following:
    ``(a) Provision of Information.--
            ``(1) In general.--The following entities shall provide the 
        information described in subsection (b) to the Secretary and, 
        in the case of an entity described in subparagraph (B) or an 
        affiliate of such entity described in subparagraph (C), to the 
        health benefits plan with which the entity is under contract, 
        at such times, and in such form and manner, as the Secretary 
        shall specify:
                    ``(A) A health benefits plan.
                    ``(B) Any entity that provides pharmacy benefits 
                management services on behalf of a health benefits plan 
                (in this section referred to as a `PBM') that manages 
                prescription drug coverage under a contract with--
                            ``(i) a PDP sponsor of a prescription drug 
                        plan or an MA organization offering an MA-PD 
                        plan under part D of title XVIII; or
                            ``(ii) a qualified health benefits plan 
                        offered through an exchange established by a 
                        State under section 1311 of the Patient 
                        Protection and Affordable Care Act.
                    ``(C) Any affiliate of an entity described in 
                subparagraph (B) that acts as a price negotiator or 
                group purchaser on behalf of such PBM, PDP sponsor, MA 
                organization, or qualified health benefits plan.
            ``(2) Affiliate defined.--In this section, the term 
        `affiliate' means any entity that is owned by, controlled by, 
        or related under a common ownership structure with a PBM 
        (including an entity owned or controlled by the PDP sponsor of 
        a prescription drug plan, MA organization offering an MA-PD 
        plan, or qualified health benefits plan for which such entity 
        is acting as a price negotiator or group purchaser).'';
            (2) in subsection (b)--
                    (A) in paragraph (2), by inserting ``and 
                percentage'' after ``and the aggregate amount''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(4) The amount (in the aggregate and disaggregated by 
        type) of all fees the PBM or an affiliate of the PBM receives 
        from all pharmaceutical manufacturers in connection with 
        patient utilization under the plan, and the amount and 
        percentage (in the aggregate and disaggregated by type) of such 
        fees that are passed through to the plan sponsor or issuer.''; 
        and
            (3) by adding at the end the following new subsection:
    ``(e) Annual Report.--The Secretary shall make publicly available 
on the Internet website of the Centers for Medicare & Medicaid Services 
an annual report that summarizes the trends observed with respect to 
data reported under subsection (b).''.
    (b) Effective Date.--The amendments made by this section shall 
apply to plan or contract years beginning on or after January 1, 2027.
    (c) Implementation.--Notwithstanding any other provision of law, 
the Secretary may implement the amendments made by this section by 
program instruction or otherwise.
    (d) Non-Application of the Paperwork Reduction Act.--Chapter 35 of 
title 44, United States Code (commonly referred to as the ``Paperwork 
Reduction Act of 1995''), shall not apply to the implementation of the 
amendments made by this section.
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