[Congressional Record Volume 169, Number 203 (Monday, December 11, 2023)]
[House]
[Pages H6762-H6789]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   LOWER COSTS, MORE TRANSPARENCY ACT

  Mrs. RODGERS of Washington. Mr. Speaker, I move to suspend the rules 
and pass the bill (H.R. 5378) to promote price transparency in the 
health care sector, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5378

       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 ``Lower Costs, More 
     Transparency Act''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

              TITLE I--IMPROVING HEALTH CARE TRANSPARENCY

Sec. 101. Hospital price transparency.
Sec. 102. Clinical diagnostic laboratory test price transparency.
Sec. 103. Imaging price transparency.
Sec. 104. Ambulatory surgical center price transparency.
Sec. 105. Health coverage price transparency.
Sec. 106. Pharmacy benefits price transparency.
Sec. 107. Reports on health care transparency tools and data.
Sec. 108. Report on integration in Medicare.
Sec. 109. Advisory Committee.
Sec. 110. Report on impact of Medicare regulations on provider and 
              payer consolidation.
Sec. 111. Implementation funding.

           TITLE II--REDUCING HEALTH CARE COSTS FOR PATIENTS

Sec. 201. Increasing transparency in generic drug applications.
Sec. 202. Improving transparency and preventing the use of abusive 
              spread pricing and related practices in Medicaid.
Sec. 203. Parity in Medicare payments for hospital outpatient 
              department services furnished off-campus.
Sec. 204. Requiring a separate identification number and an attestation 
              for each off-campus outpatient department of a provider.

 TITLE III--SUPPORTING PATIENTS, HEALTH CARE WORKERS, COMMUNITY HEALTH 
                         CENTERS, AND HOSPITALS

Sec. 301. Extension for community health centers, the national health 
              service corps, and teaching health centers that operate 
              GME programs.
Sec. 302. Extension of special diabetes programs.
Sec. 303. Delaying certain disproportionate share payment cuts.
Sec. 304. Medicaid improvement fund.

TITLE IV--INCREASING ACCESS TO QUALITY HEALTH DATA AND LOWERING HIDDEN 
                                  FEES

Sec. 401. Increasing Plan Fiduciaries' Access to Health Data.
Sec. 402. Hidden Fees Disclosure Requirements.
Sec. 403. Prescription drug price information requirement.
Sec. 404. Implementation funding.

              TITLE I--IMPROVING HEALTH CARE TRANSPARENCY

     SEC. 101. HOSPITAL PRICE TRANSPARENCY.

       (a) Medicare.--Part E of title XVIII of the Social Security 
     Act (42 U.S.C. 1395x et seq.) is amended by adding at the end 
     the following new section:

     ``SEC. 1899C. HOSPITAL PRICE TRANSPARENCY.

       ``(a) Transparency Requirement.--
       ``(1) In general.--Beginning January 1, 2026, each 
     specified hospital that receives payment under this title for 
     furnishing items and services shall comply with the price 
     transparency requirement described in paragraph (2).
       ``(2) Requirement described.--
       ``(A) In general.--For purposes of paragraph (1), the price 
     transparency requirement described in this paragraph is, with 
     respect to a specified hospital, that such hospital, in 
     accordance with a method and format established by the 
     Secretary under subparagraph (C), compile and make public 
     (without subscription and free of charge) for each year--
       ``(i) all of the hospital's standard charges (including the 
     information described in subparagraph (B)) for each item and 
     service furnished by such hospital;
       ``(ii) information in a consumer-friendly format (as 
     specified by the Secretary)--

       ``(I) on the hospital's prices (including the information 
     described in subparagraph (B)) for as many of the Centers for 
     Medicare & Medicaid Services-specified shoppable services 
     that are furnished by the hospital, and as many additional 
     hospital-selected shoppable services (or all such additional 
     services, if such hospital furnishes fewer than 300 shoppable 
     services) as may be necessary for a combined total of at 
     least 300 shoppable services; and
       ``(II) that includes, with respect to each Centers for 
     Medicare & Medicaid Services-specified shoppable service that 
     is not furnished by the hospital, an indication that such 
     service is not so furnished; and

       ``(iii) an attestation that all information made public 
     pursuant to this subparagraph is complete and accurate.
       ``(B) Information described.--For purposes of subparagraph 
     (A), the information described in this subparagraph is, with 
     respect to standard charges and prices, as applicable, made 
     public by a specified hospital, the following:
       ``(i) A plain language description of each item or service, 
     accompanied by, as applicable, the Healthcare Common 
     Procedure Coding System code, the diagnosis-related group, 
     the national drug code, or other identifier used or approved 
     by the Centers for Medicare & Medicaid Services.
       ``(ii) The gross charge, as applicable, expressed as a 
     dollar amount, for each such item or service, when provided 
     in, as applicable, the inpatient setting and outpatient 
     department setting.
       ``(iii) The discounted cash price, as applicable, expressed 
     as a dollar amount, for each such item or service when 
     provided in, as applicable, the inpatient setting and 
     outpatient department setting (or, in the case no discounted 
     cash price is available for an item or service, the median 
     cash price charged by the hospital to self-pay individuals 
     for such item or service when provided in such settings for 
     the previous three years, expressed as a dollar amount, as 
     well as, with respect to prices made public pursuant to 
     subparagraph (A)(ii), a link to a consumer-friendly document 
     that clearly explains the hospital's charity care policy that

[[Page H6763]]

     includes, if applicable, any sliding scale payment structure 
     employed for determining charges for a self-pay individual).
       ``(iv) The payer-specific negotiated charges, as 
     applicable, clearly associated with the name of the third 
     party payer and plan and expressed as a dollar amount, that 
     apply to each such item or service when provided in, as 
     applicable, the inpatient setting and outpatient department 
     setting.
       ``(v) The de-identified maximum and minimum negotiated 
     charges, as applicable, for each such item or service.
       ``(vi) Any other additional information the Secretary may 
     require for the purpose of improving the accuracy of, or 
     enabling consumers to easily understand and compare, standard 
     charges and prices for an item or service, except information 
     that is duplicative of any other reporting requirement under 
     this subsection.
     In the case of standard charges and prices for an item or 
     service included as part of a bundled, per diem, episodic, or 
     other similar arrangement, the information described in this 
     subparagraph shall be made available as determined 
     appropriate by the Secretary.
       ``(C) Uniform method and format.--Not later than January 1, 
     2026, the Secretary shall establish a standard, uniform 
     method and format for specified hospitals to use in compiling 
     and making public standard charges pursuant to subparagraph 
     (A)(i) and a standard, uniform method and format for such 
     hospitals to use in compiling and making public prices 
     pursuant to subparagraph (A)(ii). Such methods and formats--
       ``(i) shall, in the case of such method and format for 
     making public standard charges pursuant to subparagraph 
     (A)(i), ensure that such charges are made available in a 
     machine-readable format (or a successor technology specified 
     by the Secretary);
       ``(ii) may be similar to any template made available by the 
     Centers for Medicare & Medicaid Services as of the date of 
     the enactment of this subparagraph;
       ``(iii) shall meet such standards as determined appropriate 
     by the Secretary in order to ensure the accessibility and 
     usability of such charges and prices; and
       ``(iv) shall be updated as determined appropriate by the 
     Secretary, in consultation with stakeholders.
       ``(3) Monitoring compliance.--The Secretary shall, through 
     notice and comment rulemaking and in consultation with the 
     Inspector General of the Department of Health and Human 
     Services, establish a process to monitor compliance with this 
     subsection. Such process shall ensure that each specified 
     hospital's compliance with this subsection is reviewed not 
     less frequently than once every 3 years.
       ``(4) Enforcement.--
       ``(A) In general.--In the case of a specified hospital that 
     fails to comply with the requirements of this subsection--
       ``(i) not later than 30 days after the date on which the 
     Secretary determines such failure exists, the Secretary shall 
     submit to such hospital a notification of such determination 
     (which may include, as determined appropriate by the 
     Secretary, a request for a corrective action plan to comply 
     with such requirements); and
       ``(ii) in the case of a hospital that does not receive a 
     request for a corrective action plan as part of a 
     notification submitted by the Secretary under clause (i)--

       ``(I) the Secretary shall, not later than 45 days after 
     such notification is sent, determine whether such hospital is 
     in compliance with such requirements; and
       ``(II) if the Secretary determines under subclause (I) that 
     such hospital is not in compliance with such requirements, 
     the Secretary shall either--

       ``(aa) submit to such hospital a request for a corrective 
     action plan to comply with such requirements; or
       ``(bb) if the Secretary determines that such hospital has 
     not taken meaningful actions to come into compliance since 
     such notification was sent, impose a civil monetary penalty 
     in accordance with subparagraph (B).
       ``(B) Civil monetary penalty.--
       ``(i) In general.--Subject to clause (vii), in addition to 
     any other enforcement actions or penalties that may apply 
     under another provision of law, a specified hospital that has 
     received a request for a corrective action plan under clause 
     (i) or (ii) of subparagraph (A) and fails to comply with the 
     requirements of this subsection by the date that is 45 days 
     after such request is made, and a specified hospital with 
     respect to which the Secretary has made a determination 
     described in clause (ii)(II)(bb) of such subparagraph, shall 
     be subject to a civil monetary penalty of an amount specified 
     by the Secretary for each day (beginning with the day on 
     which the Secretary first determined that such hospital was 
     not complying with such requirements) during which such 
     failure was ongoing. Such amount shall not exceed--

       ``(I) in the case of a specified hospital with 30 or fewer 
     beds, $300 per day (or, in the case of such a hospital that 
     has been noncompliant with such requirements for a 1-year 
     period or longer, beginning with the first day following such 
     1-year period, $400 per day);
       ``(II) in the case of a specified hospital with more than 
     30 beds but fewer than 101 beds, $12.50 per bed per day (or, 
     in the case of such a hospital that has been noncompliant 
     with such requirements for a 1-year period or longer, 
     beginning with the first day following such 1-year period, 
     $15 per bed per day);
       ``(III) in the case of a specified hospital with more than 
     100 beds but fewer than 201 beds, $17.50 per bed per day (or, 
     in the case of such a hospital that has been noncompliant 
     with such requirements for a 1-year period or longer, 
     beginning with the first day following such 1-year period, 
     $20 per bed per day);
       ``(IV) in the case of a specified hospital with more than 
     200 beds but fewer than 501 beds, $20 per bed per day (or, in 
     the case of such a hospital that has been noncompliant with 
     such requirements for a 1-year period or longer, beginning 
     with the first day following such 1-year period, $25 per bed 
     per day); and
       ``(V) in the case of a specified hospital with more than 
     500 beds, $25 per bed per day (or, in the case of such a 
     hospital that has been noncompliant with such requirements 
     for a 1-year period or longer, beginning with the first day 
     following such 1-year period, $35 per bed per day).

       ``(ii) Increase authority.--In applying this subparagraph 
     with respect to violations occurring in 2027 or a subsequent 
     year, the Secretary may through notice and comment rulemaking 
     increase--

       ``(I) the limitation on the per day amount of any penalty 
     applicable to a specified hospital under clause (i)(I);
       ``(II) the limitations on the per bed per day amount of any 
     penalty applicable under any of subclauses (II) through (V) 
     of clause (i); and
       ``(III) the amounts specified in clause (iii)(II).

       ``(iii) Persistent noncompliance.--

       ``(I) In general.--In the case of a specified hospital 
     (other than a specified hospital with 30 or fewer beds) that 
     the Secretary has determined to be knowingly and willfully 
     noncompliant with the provisions of this subsection two or 
     more times during a 1-year period, the Secretary may increase 
     any penalty otherwise applicable under this subparagraph by 
     the amount specified in subclause (II) with respect to such 
     hospital and may require such hospital to complete such 
     additional corrective actions plans as the Secretary may 
     specify.
       ``(II) Specified amount.--For purposes of subclause (I), 
     the amount specified in this subclause is, with respect to a 
     specified hospital--

       ``(aa) with more than 30 beds but fewer than 101 beds, an 
     amount that is not less than $500,000 and not more than 
     $1,000,000;
       ``(bb) with more than 100 beds but fewer than 301 beds, an 
     amount that is greater than $1,000,000 and not more than 
     $2,000,000;
       ``(cc) with more than 300 beds but fewer than 501 beds, an 
     amount that is greater than $2,000,000 and not more than 
     $4,000,000; and
       ``(dd) with more than 500 beds, and amount that is not less 
     than $5,000,000 and not more than $10,000,000.
       ``(iv) Authority to waive or reduce penalty.--

       ``(I) In general.--Subject to subclause (II), the Secretary 
     may waive any penalty, or reduce any penalty by not more than 
     75 percent, otherwise applicable under this subparagraph with 
     respect to a specified hospital located in a rural or 
     underserved area if the Secretary certifies that imposition 
     of such penalty would result in an immediate threat to access 
     to care for individuals in the service area of such hospital.
       ``(II) Limitation on application.--The Secretary may not 
     elect to waive a penalty under subclause (I) with respect to 
     a specified hospital more than once in a 6-year period and 
     may not elect to reduce such a penalty with respect to such a 
     hospital more than once in such a period. Nothing in the 
     preceding sentence shall be construed as prohibiting the 
     Secretary from both waiving and reducing a penalty with 
     respect to a specified hospital during a 6-year period.

       ``(v) Provision of technical assistance.--The Secretary 
     shall, to the extent practicable, provide technical 
     assistance relating to compliance with the provisions of this 
     subsection to specified hospitals requesting such assistance.
       ``(vi) Application of certain provisions.--The provisions 
     of section 1128A (other than subsections (a) and (b) of such 
     section) shall apply to a civil monetary penalty imposed 
     under this subparagraph in the same manner as such provisions 
     apply to a civil monetary penalty imposed under subsection 
     (a) of such section.
       ``(vii) Nonduplication of certain penalties.--The Secretary 
     may not subject a specified hospital to a civil monetary 
     penalty under this subparagraph with respect to noncompliance 
     with the provisions of this section for a period if the 
     Secretary has imposed a civil monetary penalty on such 
     hospital under section 2718(f) of the Public Health Service 
     Act for failure to comply with the provisions of such section 
     for such period.
       ``(C) Publication of hospital price transparency 
     information.--Beginning on January 1, 2026, the Secretary 
     shall make publicly available on the public website of the 
     Centers for Medicare & Medicaid Services information with 
     respect to compliance with the requirements of this 
     subsection and enforcement activities undertaken by the 
     Secretary under this subsection. Such information shall be 
     updated in real time and include--
       ``(i) the number of reviews of compliance with this 
     subsection undertaken by the Secretary;
       ``(ii) the number of notifications described in 
     subparagraph (A)(i) sent by the Secretary;

[[Page H6764]]

       ``(iii) the identity of each specified hospital that was 
     sent such a notification and a description of the nature of 
     such hospital's noncompliance with this subsection;
       ``(iv) the amount of any civil monetary penalty imposed on 
     such hospital under subparagraph (B);
       ``(v) whether such hospital subsequently came into 
     compliance with this subsection;
       ``(vi) any waivers or reductions of penalties made pursuant 
     to a certification by the Secretary under subparagraph 
     (B)(iv), including--

       ``(I) the name of any specified hospital that received such 
     a waiver or reduction;
       ``(II) the dollar amount of each such penalty so waived or 
     reduced; and
       ``(III) the rationale for the granting of each such waiver 
     or reduction; and

       ``(vii) any other information as determined by the 
     Secretary.
       ``(b) Ensuring Accessibility Through Implementation.--In 
     implementing the amendments made by this section, the 
     Secretary of Health and Human Services shall through 
     rulemaking ensure that a hospital submitting charges and 
     information pursuant to such amendments takes reasonable 
     steps (as specified by the Secretary) to ensure the 
     accessibility of such charges and information to individuals 
     with limited English proficiency. Such steps may include the 
     hospital's provision of interpretation services or the 
     hospital's provision of translations of charges and 
     information.
       ``(c) Definitions.--For purposes of this section:
       ``(1) Discounted cash price.--The term `discounted cash 
     price' means the charge that applies to an individual who 
     pays cash, or cash equivalent, for an item or service.
       ``(2) Federal health care program.--The term `Federal 
     health care program' has the meaning given such term in 
     section 1128B.
       ``(3) Gross charge.--The term `gross charge' means the 
     charge for an individual item or service that is reflected on 
     a specified hospital's or provider of service's or 
     supplier's, as applicable, chargemaster, absent any 
     discounts.
       ``(4) Group health plan; group health insurance coverage; 
     individual health insurance coverage.--The terms `group 
     health plan', `group health insurance coverage', and 
     `individual health insurance coverage' have the meaning given 
     such terms in section 2791 of the Public Health Service Act.
       ``(5) Payer-specific negotiated charge.--The term `payer-
     specific negotiated charge' means the charge that a specified 
     hospital or provider of services or supplier, as applicable, 
     has negotiated with a third party payer for an item or 
     service.
       ``(6) Shoppable service.--The term `shoppable service' 
     means a service that can be scheduled by a health care 
     consumer in advance and includes all ancillary items and 
     services customarily furnished as part of such service.
       ``(7) Specified hospital.--The term `specified hospital' 
     means a hospital (as defined in section 1861(e)), a critical 
     access hospital (as defined in section 1861(mmm)(1)), or a 
     rural emergency hospital (as defined in section 1861(kkk)).
       ``(8) Third party payer.--The term `third party payer' 
     means an entity that is, by statute, contract, or agreement, 
     legally responsible for payment of a claim for a health care 
     item or service.''.
       (b) PHSA.--
       (1) In general.--Section 2718 of the Public Health Service 
     Act (42 U.S.C. 300gg-18) is amended by adding at the end the 
     following new subsection:
       ``(f) Hospital Transparency Requirement.--
       ``(1) In general.--Beginning January 1, 2026, each hospital 
     shall comply with the price transparency requirement 
     described in paragraph (2).
       ``(2) Requirement described.--
       ``(A) In general.--For purposes of paragraph (1), the price 
     transparency requirement described in this paragraph is, with 
     respect to a hospital, that such hospital, in accordance with 
     a method and format established by the Secretary under 
     subparagraph (C), compile and make public (without 
     subscription and free of charge) for each year--
       ``(i) all of the hospital's standard charges (including the 
     information described in subparagraph (B)) for each item and 
     service furnished by such hospital;
       ``(ii) information in a consumer-friendly format (as 
     specified by the Secretary)--

       ``(I) on the hospital's prices (including the information 
     described in subparagraph (B)) for as many of the Centers for 
     Medicare & Medicaid Services-specified shoppable services 
     that are furnished by the hospital, and as many additional 
     hospital-selected shoppable services (or all such additional 
     services, if such hospital furnishes fewer than 300 shoppable 
     services) as may be necessary for a combined total of at 
     least 300 shoppable services; and
       ``(II) that includes, with respect to each Centers for 
     Medicare & Medicaid Services-specified shoppable service that 
     is not furnished by the hospital, an indication that such 
     service is not so furnished; and

       ``(iii) an attestation that all information made public 
     pursuant to this subparagraph is complete and accurate.
       ``(B) Information described.--For purposes of subparagraph 
     (A), the information described in this subparagraph is, with 
     respect to standard charges and prices, as applicable, made 
     public by a hospital, the following:
       ``(i) A plain language description of each item or service, 
     accompanied by, as applicable, the Healthcare Common 
     Procedure Coding System code, the diagnosis-related group, 
     the national drug code, current procedure terminology codes, 
     or other identifier used or approved by the Centers for 
     Medicare & Medicaid Services.
       ``(ii) The gross charge, as applicable, expressed as a 
     dollar amount, for each such item or service, when provided 
     in, as applicable, the inpatient setting and outpatient 
     department setting.
       ``(iii) The discounted cash price, as applicable, expressed 
     as a dollar amount, for each such item or service when 
     provided in, as applicable, the inpatient setting and 
     outpatient department setting (or, in the case no discounted 
     cash price is available for an item or service, the median 
     cash price charged by the hospital to self-pay individuals 
     for such item or service when provided in such settings for 
     the previous three years, expressed as a dollar amount, as 
     well as, with respect to prices made public pursuant to 
     subparagraph (A)(ii), a link to a consumer-friendly document 
     that clearly explains the hospital's charity care policy that 
     includes, if applicable, any sliding scale payment structure 
     employed for determining charges for a self-pay individual).
       ``(iv) The payer-specific negotiated charges, as 
     applicable, clearly associated with the name of the third 
     party payer and plan and expressed as a dollar amount, that 
     apply to each such item or service when provided in, as 
     applicable, the inpatient setting and outpatient department 
     setting.
       ``(v) The de-identified maximum and minimum negotiated 
     charges, as applicable, for each such item or service.
       ``(vi) Any other additional information the Secretary may 
     require for the purpose of improving the accuracy of, or 
     enabling consumers to easily understand and compare, standard 
     charges and prices for an item or service, except information 
     that is duplicative of any other reporting requirement under 
     this subsection.
     In the case of standard charges and prices for an item or 
     service included as part of a bundled, per diem, episodic, or 
     other similar arrangement, the information described in this 
     subparagraph shall be made available as determined 
     appropriate by the Secretary.
       ``(C) Uniform method and format.--Not later than January 1, 
     2026, the Secretary shall establish a standard, uniform 
     method and format for hospitals to use in compiling and 
     making public standard charges pursuant to subparagraph 
     (A)(i) and a standard, uniform method and format for such 
     hospitals to use in compiling and making public prices 
     pursuant to subparagraph (A)(ii). Such methods and formats--
       ``(i) shall, in the case of such method and format for 
     making public standard charges pursuant to subparagraph 
     (A)(i), ensure that such charges are made available in a 
     machine-readable format (or a successor technology specified 
     by the Secretary);
       ``(ii) may be similar to any template made available by the 
     Centers for Medicare & Medicaid Services as of the date of 
     the enactment of this subparagraph;
       ``(iii) shall meet such standards as determined appropriate 
     by the Secretary in order to ensure the accessibility and 
     usability of such charges and prices; and
       ``(iv) shall be updated as determined appropriate by the 
     Secretary, in consultation with stakeholders.
       ``(3) Monitoring compliance.--The Secretary shall, through 
     notice and comment rulemaking and in consultation with the 
     Inspector General of the Department of Health and Human 
     Services, establish a process to monitor compliance with this 
     subsection. Such process shall ensure that each hospital's 
     compliance with this subsection is reviewed not less 
     frequently than once every 3 years.
       ``(4) Enforcement.--
       ``(A) In general.--In the case of a hospital that fails to 
     comply with the requirements of this subsection--
       ``(i) not later than 30 days after the date on which the 
     Secretary determines such failure exists, the Secretary shall 
     submit to such hospital a notification of such determination 
     (which may include, as determined appropriate by the 
     Secretary, a request for a corrective action plan to comply 
     with such requirements); and
       ``(ii) in the case of a hospital that does not receive a 
     request for a corrective action plan as part of a 
     notification submitted by the Secretary under clause (i)--

       ``(I) the Secretary shall, not later than 45 days after 
     such notification is sent, determine whether such hospital is 
     in compliance with such requirements; and
       ``(II) if the Secretary determines under subclause (I) that 
     such hospital is not in compliance with such requirements, 
     the Secretary shall either--

       ``(aa) submit to such hospital a request for a corrective 
     action plan to comply with such requirements; or
       ``(bb) if the Secretary determines that such hospital has 
     not taken meaningful actions to come into compliance since 
     such notification was sent, impose a civil monetary penalty 
     in accordance with subparagraph (B).
       ``(B) Civil monetary penalty.--
       ``(i) In general.--In addition to any other enforcement 
     actions or penalties that may apply under another provision 
     of law, a hospital that has received a request for a 
     corrective action plan under clause (i) or (ii) of 
     subparagraph (A) and fails to comply with the requirements of 
     this subsection by the

[[Page H6765]]

     date that is 45 days after such request is made, and a 
     hospital with respect to which the Secretary has made a 
     determination described in clause (ii)(II)(bb) of such 
     subparagraph, shall be subject to a civil monetary penalty of 
     an amount specified by the Secretary for each day (beginning 
     with the day on which the Secretary first determined that 
     such hospital was not complying with such requirements) 
     during which such failure was ongoing. Such amount shall not 
     exceed--

       ``(I) in the case of a hospital with 30 or fewer beds, $300 
     per day (or, in the case of such a hospital that has been 
     noncompliant with such requirements for a 1-year period or 
     longer, beginning with the first day following such 1-year 
     period, $400 per bed per day);
       ``(II) in the case of a hospital with more than 30 beds but 
     fewer than 101 beds, $12.50 per bed per day (or, in the case 
     of such a hospital that has been noncompliant with such 
     requirements for a 1-year period or longer, beginning with 
     the first day following such 1-year period, $15 per bed per 
     day);
       ``(III) in the case of a hospital with more than 100 beds 
     but fewer than 201 beds, $17.50 per bed per day (or, in the 
     case of such a hospital that has been noncompliant with such 
     requirements for a 1-year period or longer, beginning with 
     the first day following such 1-year period, $20 per bed per 
     day);
       ``(IV) in the case of a hospital with more than 200 beds 
     but fewer than 501 beds, $20 per bed per day (or, in the case 
     of such a hospital that has been noncompliant with such 
     requirements for a 1-year period or longer, beginning with 
     the first day following such 1-year period, $25 per bed per 
     day); and
       ``(V) in the case of a hospital with more than 500 beds, 
     $25 per bed per day (or, in the case of such a hospital that 
     has been noncompliant with such requirements for a 1-year 
     period or longer, beginning with the first day following such 
     1-year period, $35 per bed per day).

       ``(ii) Increase authority.--In applying this subparagraph 
     with respect to violations occurring in 2027 or a subsequent 
     year, the Secretary may through notice and comment rulemaking 
     increase--

       ``(I) the limitation on the per day amount of any penalty 
     applicable to a hospital under clause (i)(I);
       ``(II) the limitations on the per bed per day amount of any 
     penalty applicable under any of subclauses (II) through (V) 
     of clause (i); and
       ``(III) the amounts specified in clause (iii)(II).

       ``(iii) Persistent noncompliance.--

       ``(I) In general.--In the case of a hospital (other than a 
     hospital with 30 or fewer beds) that the Secretary has 
     determined to be knowingly and willfully noncompliant with 
     the provisions of this subsection two or more times during a 
     1-year period, the Secretary may increase any penalty 
     otherwise applicable under this subparagraph by the amount 
     specified in subclause (II) with respect to such hospital and 
     may require such hospital to complete such additional 
     corrective actions plans as the Secretary may specify.
       ``(II) Specified amount.--For purposes of subclause (I), 
     the amount specified in this subclause is, with respect to a 
     hospital--

       ``(aa) with more than 30 beds but fewer than 101 beds, an 
     amount that is not less than $500,000 and not more than 
     $1,000,000;
       ``(bb) with more than 100 beds but fewer than 301 beds, an 
     amount that is greater than $1,000,000 and not more than 
     $2,000,000;
       ``(cc) with more than 300 beds but fewer than 501 beds, an 
     amount that is greater than $2,000,000 and not more than 
     $4,000,000; and
       ``(dd) with more than 500 beds, and amount that is not less 
     than $5,000,000 and not more than $10,000,000.
       ``(iv) Authority to waive or reduce penalty.--

       ``(I) In general.--Subject to subclause (II), the Secretary 
     may waive any penalty, or reduce any penalty by not more than 
     75 percent, otherwise applicable under this subparagraph with 
     respect to a hospital located in a rural or underserved area 
     if the Secretary certifies that imposition of such penalty 
     would result in an immediate threat to access to care for 
     individuals in the service area of such hospital.
       ``(II) Limitation on application.--The Secretary may not 
     elect to waive a penalty under subclause (I) with respect to 
     a hospital more than once in a 6-year period and may not 
     elect to reduce such a penalty with respect to such a 
     hospital more than once in such a period. Nothing in the 
     preceding sentence shall be construed as prohibiting the 
     Secretary from both waiving and reducing a penalty with 
     respect to a hospital during a 6-year period.

       ``(v) Provision of technical assistance.--The Secretary 
     shall, to the extent practicable, provide technical 
     assistance relating to compliance with the provisions of this 
     section to hospitals requesting such assistance.
       ``(vi) Application of certain provisions.--The provisions 
     of section 1128A (other than subsections (a) and (b) of such 
     section) shall apply to a civil monetary penalty imposed 
     under this subparagraph in the same manner as such provisions 
     apply to a civil monetary penalty imposed under subsection 
     (a) of such section.
       ``(vii) Nonduplication of penalties.--The Secretary may not 
     subject a hospital to a civil monetary penalty under this 
     subparagraph with respect to noncompliance with the 
     provisions of this subsection for a period if the Secretary 
     has imposed a civil monetary penalty on such hospital under 
     section 1899C of the Social Security Act for failure to 
     comply with the provisions of such section for such period.
       ``(C) Publication of hospital price transparency 
     information.--Beginning on January 1, 2026, the Secretary 
     shall make publicly available on the public website of the 
     Centers for Medicare & Medicaid Services information with 
     respect to compliance with the requirements of this 
     subsection and enforcement activities undertaken by the 
     Secretary under this subsection. Such information shall be 
     updated in real time and include--
       ``(i) the number of reviews of compliance with this 
     subsection undertaken by the Secretary;
       ``(ii) the number of notifications described in 
     subparagraph (A)(i) sent by the Secretary;
       ``(iii) the identity of each hospital that was sent such a 
     notification and a description of the nature of such 
     hospital's noncompliance with this subsection;
       ``(iv) the amount of any civil monetary penalty imposed on 
     such hospital under subparagraph (B);
       ``(v) whether such hospital subsequently came into 
     compliance with this subsection;
       ``(vi) any waivers or reductions of penalties made pursuant 
     to a certification by the Secretary under subparagraph 
     (B)(iv), including--

       ``(I) the name of any hospital that received such a waiver 
     or reduction;
       ``(II) the dollar amount of each such penalty so waived or 
     reduced; and
       ``(III) the rationale for the granting of each such waiver 
     or reduction; and

       ``(vii) any other information as determined by the 
     Secretary.
       ``(5) Ensuring accessibility through implementation.--In 
     implementing the amendments made by this section, the 
     Secretary of Health and Human Services shall through 
     rulemaking ensure that a hospital submitting charges and 
     information pursuant to such amendments takes reasonable 
     steps (as specified by the Secretary) to ensure the 
     accessibility of such charges and information to individuals 
     with limited English proficiency. Such steps may include the 
     hospital's provision of interpretation services or the 
     hospital's provision of translations of charges and 
     information.
       ``(6) Definitions.--For purposes of this subsection:
       ``(A) Discounted cash price.--The term `discounted cash 
     price' means the charge that applies to an individual who 
     pays cash, or cash equivalent, for a hospital-furnished item 
     or service.
       ``(B) Federal health care program.--The term `Federal 
     health care program' has the meaning given such term in 
     section 1128B of the Social Security Act.
       ``(C) Gross charge.--The term `gross charge' means the 
     charge for an individual item or service that is reflected on 
     a hospital's chargemaster, absent any discounts.
       ``(D) Payer-specific negotiated charge.--The term `payer-
     specific negotiated charge' means the charge that a hospital 
     has negotiated with a third party payer for an item or 
     service.
       ``(E) Shoppable service.--The term `shoppable service' 
     means a service that can be scheduled by a health care 
     consumer in advance and includes all ancillary items and 
     services customarily furnished as part of such service.
       ``(F) Third party payer.--The term `third party payer' 
     means an entity that is, by statute, contract, or agreement, 
     legally responsible for payment of a claim for a health care 
     item or service.''.
       (2) Conforming amendments.--Section 2718 of the Public 
     Health Service Act (42 U.S.C. 300gg-18) is amended--
       (A) in subsection (b)(3), by inserting ``(other than the 
     provisions of subsection (f))'' after ``this section''; and
       (B) in subsection (e), by adding at the end the following 
     new sentence: ``The preceding provisions of this subsection 
     shall not apply beginning on January 1, 2026.''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply beginning January 1, 2026.
       (c) Accessibility Through Implementation.--In implementing 
     the amendments made by this section, the Secretary of Health 
     and Human Services shall through rulemaking ensure that a 
     hospital submitting charges and information pursuant to such 
     amendments takes reasonable steps (as specified by the 
     Secretary) to ensure the accessibility of such charges and 
     information to individuals with limited English proficiency. 
     Such steps may include the hospital's provision of 
     interpretation services or the hospital's provision of 
     translations of charges and information.

     SEC. 102. CLINICAL DIAGNOSTIC LABORATORY TEST PRICE 
                   TRANSPARENCY.

       Section 1846 of the Social Security Act (42 U.S.C. 1395w-2) 
     is amended--
       (1) in the header, by inserting ``and additional 
     requirements'' after ``sanctions''; and
       (2) by adding at the end the following new subsection:
       ``(c) Price Transparency Requirement.--
       ``(1) In general.--Beginning January 1, 2026, any 
     applicable laboratory that receives payment under this title 
     for furnishing any specified clinical diagnostic laboratory 
     test under this title shall--
       ``(A) make publicly available on an internet website the 
     information described in

[[Page H6766]]

     paragraph (2) with respect to each such specified clinical 
     diagnostic laboratory test that such laboratory so furnishes; 
     and
       ``(B) ensure that such information is updated not less 
     frequently than annually.
       ``(2) Information described.--For purposes of paragraph 
     (1), the information described in this paragraph is, with 
     respect to an applicable laboratory and a specified clinical 
     diagnostic laboratory test, the following:
       ``(A) The discounted cash price for such test (or, if no 
     such price exists, the gross charge for such test).
       ``(B) The deidentified minimum payer-specific negotiated 
     charge between such laboratory and any third party payer for 
     such test.
       ``(C) The deidentified maximum payer-specific negotiated 
     charge between such laboratory and any third party payer for 
     such test.
       ``(3) Uniform method and format.--Not later than January 1, 
     2026, the Secretary shall establish a standard, uniform 
     method and format for applicable laboratories to use in 
     compiling and making public information pursuant to paragraph 
     (1). Such method and format--
       ``(A) may be similar to any template made available by the 
     Centers for Medicare & Medicaid Services (as described in 
     section 1899C(a)(2)(C)(ii));
       ``(B) shall meet such standards as determined appropriate 
     by the Secretary in order to ensure the accessibility and 
     usability of such information; and
       ``(C) shall be updated as determined appropriate by the 
     Secretary, in consultation with stakeholders.
       ``(4) Inclusion of ancillary services.--Any price or rate 
     for a specified clinical diagnostic laboratory test available 
     to be furnished by an applicable laboratory made publicly 
     available in accordance with paragraph (1) shall include the 
     price or rate (as applicable) for any ancillary item or 
     service (such as specimen collection services) that would 
     normally be furnished by such laboratory as part of such 
     test, as specified by the Secretary.
       ``(5) Enforcement.--
       ``(A) In general.--In the case that the Secretary 
     determines that an applicable laboratory is not in compliance 
     with paragraph (1)--
       ``(i) not later than 30 days after such determination, the 
     Secretary shall notify such laboratory of such determination; 
     and
       ``(ii) if such laboratory continues to fail to comply with 
     such paragraph after the date that is 90 days after such 
     notification is sent, the Secretary may impose a civil 
     monetary penalty in an amount not to exceed $300 for each 
     (beginning with the day on which the Secretary first 
     determined that such laboratory was failing to comply with 
     such paragraph) during which such failure is ongoing.
       ``(B) Increase authority.--In applying this paragraph with 
     respect to violations occurring in 2027 or a subsequent year, 
     the Secretary may through notice and comment rulemaking 
     increase the per day limitation on civil monetary penalties 
     under subparagraph (A)(ii).
       ``(C) Application of certain provisions.--The provisions of 
     section 1128A (other than subsections (a) and (b) of such 
     section) shall apply to a civil monetary penalty imposed 
     under this paragraph in the same manner as such provisions 
     apply to a civil monetary penalty imposed under subsection 
     (a) of such section.
       ``(6) Provision of technical assistance.--The Secretary 
     shall, to the extent practicable, provide technical 
     assistance relating to compliance with the provisions of this 
     subsection to applicable laboratories requesting such 
     assistance.
       ``(7) Definitions.--In this subsection:
       ``(A) Applicable laboratory.--The term `applicable 
     laboratory' has the meaning given such term in section 
     414.502, of title 42, Code of Federal Regulations (or a 
     successor regulation), except that such term does not include 
     a laboratory with respect to which standard charges and 
     prices for specified clinical diagnostic laboratory tests 
     furnished by such laboratory are made available by a hospital 
     pursuant to section 1899C or section 2718(f) of the Public 
     Health Service Act.
       ``(B) Discounted cash price.--The term `discounted cash 
     price' means the charge that applies to an individual who 
     pays cash, or cash equivalent, for an item or service.
       ``(C) Gross charge.--The term `gross charge' means the 
     charge for an individual item or service that is reflected on 
     an applicable laboratory's chargemaster, absent any 
     discounts.
       ``(D) Payer-specific negotiated charge.--The term `payer-
     specific negotiated charge' means the charge that an 
     applicable laboratory has negotiated with a third party payer 
     for an item or service.
       ``(E) Specified clinical diagnostic laboratory test.--the 
     term `specified clinical diagnostic laboratory test' means a 
     clinical diagnostic laboratory test that is included on the 
     list of shoppable services specified by the Centers for 
     Medicare & Medicaid Services (as described in section 
     1899C(a)(2)(A)(ii)(I)), other than such a test that is only 
     available to be furnished by a single provider of services or 
     supplier.
       ``(F) Third party payer.--The term `third party payer' 
     means an entity that is, by statute, contract, or agreement, 
     legally responsible for payment of a claim for a health care 
     item or service.''.

     SEC. 103. IMAGING PRICE TRANSPARENCY.

       Section 1899C of the Social Security Act, as added by 
     section 101, is amended--
       (1) by redesignating subsection (b) as subsection (c);
       (2) by inserting after subsection (a) the following new 
     subsection:
       ``(b) Imaging Services Price Transparency.--
       ``(1) In general.--Beginning January 1, 2028, each provider 
     of services and supplier that receives payment under this 
     title for furnishing a specified imaging service, other than 
     such a provider or supplier with respect to which standard 
     charges and prices for such services furnished by such 
     provider or supplier are made available by a hospital 
     pursuant to section 1899C or section 2718(f) of the Public 
     Health Service Act, shall--
       ``(A) make publicly available (in accordance with paragraph 
     (3)) on an internet website the information described in 
     paragraph (2) with respect to each such service that such 
     provider of services or supplier furnishes; and
       ``(B) ensure that such information is updated not less 
     frequently than annually.
       ``(2) Information described.--For purposes of paragraph 
     (1), the information described in this paragraph is, with 
     respect to a provider of services or supplier and a specified 
     imaging service, the following:
       ``(A) The discounted cash price for such service (or, if no 
     such price exists, the gross charge for such service).
       ``(B) If required by the Secretary, the deidentified 
     minimum payer-specific negotiated charge for such service and 
     the deidentified maximum payer-specific negotiated charge for 
     such service.
       ``(3) Uniform method and format.--Not later than January 1, 
     2028, the Secretary shall establish a standard, uniform 
     method and format for providers of services and suppliers to 
     use in making public information described in paragraph (2). 
     Any such method and format--
       ``(A) may be similar to any template made available by the 
     Centers for Medicare & Medicaid Services (as described in 
     section 1899C(a)(2)(C)(ii));
       ``(B) shall meet such standards as determined appropriate 
     by the Secretary in order to ensure the accessibility and 
     usability of such information; and
       ``(C) shall be updated as determined appropriate by the 
     Secretary, in consultation with stakeholders.
       ``(4) Monitoring compliance.--The Secretary shall, through 
     notice and comment rulemaking and in consultation with the 
     Inspector General of the Department of Health and Human 
     Services, establish a process to monitor compliance with this 
     subsection.
       ``(5) Enforcement.--
       ``(A) In general.--In the case that the Secretary 
     determines that a provider of services or supplier is not in 
     compliance with paragraph (1)--
       ``(i) not later than 30 days after such determination, the 
     Secretary shall notify such provider or supplier of such 
     determination;
       ``(ii) upon request of the Secretary, such provider or 
     supplier shall submit to the Secretary, not later than 45 
     days after the date of such request, a corrective action plan 
     to comply with such paragraph; and
       ``(iii) if such provider or supplier continues to fail to 
     comply with such paragraph after the date that is 90 days 
     after such notification is sent (or, in the case of such a 
     provider or supplier that has submitted a corrective action 
     plan described in clause (ii) in response to a request so 
     described, after the date that is 90 days after such 
     submission), the Secretary may impose a civil monetary 
     penalty in an amount not to exceed $300 for each day 
     (beginning with the day on which the Secretary first 
     determined that such provider or supplier was failing to 
     comply with such paragraph) during which such failure to 
     comply or failure to submit is ongoing.
       ``(B) Increase authority.--In applying this paragraph with 
     respect to violations occurring in 2029 or a subsequent year, 
     the Secretary may through notice and comment rulemaking 
     increase the amount of the civil monetary penalty under 
     subparagraph (A)(iii).
       ``(C) Application of certain provisions.--The provisions of 
     section 1128A (other than subsections (a) and (b) of such 
     section) shall apply to a civil monetary penalty imposed 
     under this paragraph in the same manner as such provisions 
     apply to a civil monetary penalty imposed under subsection 
     (a) of such section.
       ``(D) Authority to waive or reduce penalty.--
       ``(i) In general.--Subject to clause (ii), the Secretary 
     may waive or reduce any penalty otherwise applicable with 
     respect to a provider of services or supplier under this 
     subparagraph if the Secretary certifies that imposition of 
     such penalty would result in an immediate threat to access to 
     care for individuals in the service area of such provider or 
     supplier.
       ``(ii) Limitation.--The Secretary may not elect to waive or 
     reduce a penalty under clause (i) with respect to a specific 
     provider of services or supplier more than 3 times.
       ``(E) Provision of technical assistance.--The Secretary 
     shall, to the extent practicable, provide technical 
     assistance relating to compliance with the provisions of this 
     subsection to providers of services and suppliers requesting 
     such assistance.
       ``(F) Clarification of nonapplicability of other 
     enforcement provisions.--Notwithstanding any other provision 
     of this title, this paragraph shall be the sole means of 
     enforcing the provisions of this subsection.''; and

[[Page H6767]]

       (3) in subsection (c), as so redesignated by paragraph 
     (1)--
       (A) by redesignating paragraph (8) as paragraph (9); and
       (B) by inserting after paragraph (7) the following new 
     paragraph:
       ``(8) Specified imaging service.--the term `specified 
     imaging service' means an imaging service that is a Centers 
     for Medicare & Medicaid Services-specified shoppable service 
     (as described in subsection (a)(2)(A)(ii)(I)).''.

     SEC. 104. AMBULATORY SURGICAL CENTER PRICE TRANSPARENCY.

       Section 1834 of the Social Security Act (42 U.S.C. 1395m) 
     is amended by adding at the end the following new subsection:
       ``(aa) Ambulatory Surgical Center Price Transparency.--
       ``(1) In general.--Beginning January 1, 2026, each 
     ambulatory surgical center that receives payment under this 
     title for furnishing items and services shall comply with the 
     price transparency requirement described in paragraph (2).
       ``(2) Requirement described.--
       ``(A) In general.--For purposes of paragraph (1), the price 
     transparency requirement described in this subsection is, 
     with respect to an ambulatory surgical center, that such 
     surgical center in accordance with a method and format 
     established by the Secretary under subparagraph (C), compile 
     and make public (without subscription and free of charge), 
     for each year--
       ``(i) all of the ambulatory surgical center's standard 
     charges (including the information described in subparagraph 
     (B)) for each item and service furnished by such surgical 
     center;
       ``(ii) information on the ambulatory surgical center's 
     prices (including the information described in subparagraph 
     (B)) for as many of the Centers for Medicare & Medicaid 
     Services-specified shoppable services that are furnished by 
     such surgical center, and as many additional ambulatory 
     surgical center-selected shoppable services (or all such 
     additional services, if such surgical center furnishes fewer 
     than 300 shoppable services) as may be necessary for a 
     combined total of at least 300 shoppable services; and
       ``(iii) with respect to each Centers for Medicare & 
     Medicaid Services-specified shoppable service that is not 
     furnished by the ambulatory surgical center, an indication 
     that such service is not so furnished.
       ``(B) Information described.--For purposes of subparagraph 
     (A), the information described in this subparagraph is, with 
     respect to standard charges and prices (as applicable) made 
     public by an ambulatory surgical center, the following:
       ``(i) A plain language description of each item or service, 
     accompanied by, as applicable, the Healthcare Common 
     Procedure Coding System code, the diagnosis-related group, 
     the national drug code, or other identifier used or approved 
     by the Centers for Medicare & Medicaid Services.
       ``(ii) The gross charge, as applicable, expressed as a 
     dollar amount, for each such item or service.
       ``(iii) The discounted cash price, as applicable, expressed 
     as a dollar amount, for each such item or service (or, in the 
     case no discounted cash price is available for an item or 
     service, the median cash price charged to self-pay 
     individuals for such item or service for the previous three 
     years, expressed as a dollar amount).
       ``(iv) The current payer-specific negotiated charges, 
     clearly associated with the name of the third party payer and 
     plan and expressed as a dollar amount, that applies to each 
     such item or service.
       ``(v) The de-identified maximum and minimum negotiated 
     charges, as applicable, for each such item or service.
       ``(vi) Any other additional information the Secretary may 
     require for the purpose of improving the accuracy of, or 
     enabling consumers to easily understand and compare, standard 
     charges and prices for an item or service, except information 
     that is duplicative of any other reporting requirement under 
     this subsection.
       ``(C) Uniform method and format.--Not later than January 1, 
     2026, the Secretary shall establish a standard, uniform 
     method and format for ambulatory surgical centers to use in 
     making public standard charges and a standard, uniform method 
     and format for such centers to use in making public prices 
     pursuant to subparagraph (A). Any such method and format--
       ``(i) shall, in the case of such charges made public by an 
     ambulatory surgical center, ensure that such charges are made 
     available in a machine-readable format (or successor 
     technology);
       ``(ii) may be similar to any template made available by the 
     Centers for Medicare & Medicaid Services as of the date of 
     the enactment of this paragraph;
       ``(iii) shall meet such standards as determined appropriate 
     by the Secretary in order to ensure the accessibility and 
     usability of such charges and prices; and
       ``(iv) shall be updated as determined appropriate by the 
     Secretary, in consultation with stakeholders.
       ``(3) Monitoring compliance.--The Secretary shall, through 
     notice and comment rulemaking and in consultation with the 
     Inspector General of the Department of Health and Human 
     Services, establish a process to monitor compliance with this 
     subsection. Such process shall ensure that each ambulatory 
     surgical center's compliance with this subsection is reviewed 
     not less frequently than once every 3 years.
       ``(4) Enforcement.--
       ``(A) In general.--In the case of an ambulatory surgical 
     center that fails to comply with the requirements of this 
     subsection--
       ``(i) the Secretary shall notify such ambulatory surgical 
     center of such failure not later than 30 days after the date 
     on which the Secretary determines such failure exists; and
       ``(ii) upon request of the Secretary, the ambulatory 
     surgical center shall submit to the Secretary, not later than 
     45 days after the date of such request, a corrective action 
     plan to comply with such requirements.
       ``(B) Civil monetary penalty.--
       ``(i) In general.--In addition to any other enforcement 
     actions or penalties that may apply under another provision 
     of law, an ambulatory surgical center that has received a 
     notification under subparagraph (A)(i) and fails to comply 
     with the requirements of this subsection by the date that is 
     90 days after such notification (or, in the case of an 
     ambulatory surgical center that has submitted a corrective 
     action plan described in subparagraph (A)(ii) in response to 
     a request so described, by the date that is 90 days after 
     such submission) shall be subject to a civil monetary penalty 
     of an amount specified by the Secretary for each subsequent 
     day during which such failure is ongoing (not to exceed $300 
     per day).
       ``(ii) Increase authority.--In applying this subparagraph 
     with respect to violations occurring in 2027 or a subsequent 
     year, the Secretary may through notice and comment rulemaking 
     increase the limitation on the per day amount of any penalty 
     applicable to an ambulatory surgical center under clause (i).
       ``(iii) Application of certain provisions.--The provisions 
     of section 1128A (other than subsections (a) and (b) of such 
     section) shall apply to a civil monetary penalty imposed 
     under this subparagraph in the same manner as such provisions 
     apply to a civil monetary penalty imposed under subsection 
     (a) of such section.
       ``(iv) Authority to waive or reduce penalty.--

       ``(I) In general.--Subject to subclause (II), the Secretary 
     may waive any penalty, or reduce any penalty by not more than 
     75 percent, otherwise applicable under this subparagraph with 
     respect to an ambulatory surgical center located in a rural 
     or underserved area if the Secretary certifies that 
     imposition of such penalty would result in an immediate 
     threat to access to care for individuals in the service area 
     of such surgical center.
       ``(II) Limitation on application.--The Secretary may not 
     elect to waive a penalty under subclause (I) with respect to 
     an ambulatory surgical center more than once in a 6-year 
     period and may not elect to reduce such a penalty with 
     respect to such a surgical center more than once in such a 
     period. Nothing in the preceding sentence shall be construed 
     as prohibiting the Secretary from both waiving and reducing a 
     penalty with respect to an ambulatory surgical center during 
     a 6-year period.

       ``(5) Definitions.--For purposes of this section:
       ``(A) Discounted cash price.--The term `discounted cash 
     price' means the charge that applies to an individual who 
     pays cash, or cash equivalent, for a item or service 
     furnished by an ambulatory surgical center.
       ``(B) Federal health care program.--The term `Federal 
     health care program' has the meaning given such term in 
     section 1128B.
       ``(C) Gross charge.--The term `gross charge' means the 
     charge for an individual item or service that is reflected on 
     an ambulatory surgical center's chargemaster, absent any 
     discounts.
       ``(D) Group health plan; group health insurance coverage; 
     individual health insurance coverage.--The terms `group 
     health plan', `group health insurance coverage', and 
     `individual health insurance coverage' have the meaning given 
     such terms in section 2791 of the Public Health Service Act.
       ``(E) Payer-specific negotiated charge.--The term `payer-
     specific negotiated charge' means the charge that an 
     ambulatory surgical center has negotiated with a third party 
     payer for an item or service.
       ``(F) Shoppable service.--The term `shoppable service' 
     means a service that can be scheduled by a health care 
     consumer in advance and includes all ancillary items and 
     services customarily furnished as part of such service.
       ``(G) Third party payer.--The term `third party payer' 
     means an entity that is, by statute, contract, or agreement, 
     legally responsible for payment of a claim for a health care 
     item or service.''.

     SEC. 105. HEALTH COVERAGE PRICE TRANSPARENCY.

       (a) Price Transparency Requirements.--
       (1) IRC.--
       (A) In general.--Section 9819 of the Internal Revenue Code 
     of 1986 is amended to read as follows:

     ``SEC. 9819. TRANSPARENCY IN COVERAGE.

       ``(a) Cost-sharing Transparency.--
       ``(1) In general.--For plan years beginning on or after 
     January 1, 2026, a group health plan shall permit a 
     participant or beneficiary to learn the amount of cost-
     sharing (including deductibles, copayments, and coinsurance) 
     under the participant 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 in a timely manner upon the request of the 
     participant or beneficiary. At a minimum, such information

[[Page H6768]]

     shall include the information specified in paragraph (2) and 
     shall be made available to such participant or beneficiary 
     through a self-service tool that meets the requirements of 
     paragraph (3) or, at the option of such participant or 
     beneficiary, through a paper disclosure or phone or other 
     electronic disclosure (as selected by such participant or 
     beneficiary and provided at no cost to such 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 (c)) for such item or service.
       ``(B) If such provider is not a participating provider with 
     respect to such item or service, the maximum allowed amount 
     or other dollar amount that such plan or coverage will 
     recognize as payment for such item or service, along with a 
     notice that such participant or beneficiary may be liable for 
     additional charges.
       ``(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 maximum allowed amount or other 
     dollar amount described in such subparagraph).
       ``(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) 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.
       ``(F) Any prior authorization, concurrent review, step 
     therapy, fail first, or similar requirements applicable to 
     coverage of such item or service under such plan.
       ``(G) Any shared savings (such as any credit, payment, or 
     other benefit provided by such plan) available to the 
     participant or beneficiary with respect to such item or 
     service furnished by such provider known at the time such 
     request is made.
       ``(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 (or successor 
     technology specified 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 timely and 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; or
       ``(ii) all providers that are participating providers with 
     respect to such item or service;
       ``(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; and
       ``(F) meets any other requirement determined appropriate by 
     the Secretary to ensure the accessibility and usability of 
     information provided through such tool.
     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 similar items and services.
       ``(b) Rate and Payment Information.--
       ``(1) In general.--For plan years beginning on or after 
     January 1, 2026, each group health plan (other than a 
     grandfathered health plan (as defined in section 1251(e) of 
     the Patient Protection and Affordable Care Act)) shall, for 
     each month, not later than the tenth day of such month, make 
     available to the public the rate and payment information 
     described in paragraph (2) in accordance with paragraph (3).
       ``(2) Rate and payment information described.--For purposes 
     of paragraph (1), the rate and payment information described 
     in this paragraph 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 (expressed as a dollar amount) in effect as 
     of the date on which such information is made public with 
     each provider that is a participating provider with respect 
     to such item or service.
       ``(B) With respect to each drug (identified by national 
     drug code) for which benefits are available under such plan--
       ``(i) the in-network rate (expressed as a dollar amount) in 
     effect as of the first day of the month in which such 
     information is made public with each provider that is a 
     participating provider with respect to such drug; 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 publication to each provider 
     that was a participating provider with respect to such drug, 
     broken down by each such provider, other than such an amount 
     paid to a provider that, during such period, submitted fewer 
     than 20 claims for such drug to such plan.
       ``(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.
       ``(3) Manner of publication.--Rate and payment information 
     required to be made available under this subsection shall be 
     so made available in dollar amounts through separate machine-
     readable files (and any successor technology, such as 
     application program interface technology, determined 
     appropriate by the Secretary) corresponding to the 
     information described in each of subparagraphs (A) through 
     (C) of paragraph (2) that meet such requirements as specified 
     by the Secretary through subregulatory guidance. Such 
     requirements shall ensure that such files are limited to an 
     appropriate size, do not include disclosure of unnecessary 
     duplicative information contained in other files made 
     available under this subsection, are made available in a 
     widely available format through a publicly available website 
     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.
       ``(4) User instructions.--Each group health plan shall make 
     available to the public instructions written in plain 
     language explaining how individuals may search for 
     information described in paragraph (2) in files submitted in 
     accordance with paragraph (3). The Secretary shall develop 
     and publish through subregulatory guidance a template that 
     such a plan may use in developing instructions for purposes 
     of the preceding sentence.
       ``(5) Summary.--For each plan year beginning on or after 
     January 1, 2026, each group health plan shall make public a 
     data file, in a manner that ensures that such file may be 
     easily downloaded and read by standard spreadsheet software 
     and that meets such requirements as established by the 
     Secretary, containing a summary of all rate and payment 
     information made public by such plan with respect to such 
     plan during such plan year. Such file shall include the 
     following:
       ``(A) The mean, median, and interquartile range of the in-
     network rate, and the amount allowed for an item or service 
     when not furnished by a participating provider, in effect as 
     of the first day of such plan year for each item or service 
     (identified by payer identifier approved or used by the 
     Centers for Medicare & Medicaid Services) for which benefits 
     are available under the plan, broken down by the type of 
     provider furnishing the item or service and by the geographic 
     area in which such item or service is furnished.
       ``(B) Trends in payment rates for such items and services 
     over such plan year, including an identification of instances 
     in which such rates have increased, decreased, or remained 
     the same.
       ``(C) The name of such plan, a description of the type of 
     network of participating providers used by such plan, and a 
     description of whether such plan is self-insured or fully-
     insured.
       ``(D) For each item or service which is paid as part of a 
     bundled rate--
       ``(i) a description of the formulae, pricing methodologies, 
     or other information used to calculate the payment rate for 
     such bundle; and
       ``(ii) a list of the items and services included in such 
     bundle.
       ``(E) The percentage of items and services that are paid 
     for on a fee-for-service basis and the percentage of items 
     and services that are paid for as part of a bundled rate, 
     capitated payment rate, or other alternative payment model.
       ``(6) Attestation.--Each group health plan shall post, 
     along with rate and payment information made public by such 
     plan, an attestation that such information is complete and 
     accurate.
       ``(c) Accessibility.--A group health plan shall take 
     reasonable steps (as specified by the Secretary) to ensure 
     that information provided in response to a request described 
     in subsection (a), and rate and payment information made 
     public under subsection (b), is provided in plain, easily 
     understandable language and that interpretation, 
     translations, and assistive services are provided to those 
     with limited English proficiency and those with disabilities.
       ``(d) Definitions.--In this section:
       ``(1) Participating provider.--The term `participating 
     provider' means, with respect to an item or service and a 
     group health plan, a physician or other health care provider 
     who is acting within the scope of practice of that provider's 
     license or certification under applicable State law and who 
     has a

[[Page H6769]]

     contractual relationship with the plan, respectively, for 
     furnishing such item or service under the plan, and includes 
     facilities, respectively.
       ``(2) Provider.--The term `provider' includes a health care 
     facility.
       ``(3) 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, regardless of 
     whether such rate is calculated based on a set amount, a fee 
     schedule, or an amount derived from another amount, or a 
     formula, or other method.''.
       (B) Clerical amendment.--The item relating to section 9819 
     of 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. Transparency in coverage.''.
       (2) 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. TRANSPARENCY IN COVERAGE.

       ``(a) Cost-sharing Transparency.--
       ``(1) In general.--For plan years beginning on or after 
     January 1, 2026, a group health plan and a health insurance 
     issuer offering group or individual health insurance coverage 
     shall permit an individual enrolled under such plan or 
     coverage to learn the amount of cost-sharing (including 
     deductibles, copayments, and coinsurance) under the 
     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 a provider in a timely manner 
     upon the request of the individual. At a minimum, such 
     information shall include the information specified in 
     paragraph (2) and shall be made available to such individual 
     through a self-service tool that meets the requirements of 
     paragraph (3) or, at the option of such individual, through a 
     paper disclosure or phone or other electronic disclosure (as 
     selected by such individual and provided at no cost to such 
     individual) 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 furnished by a health care provider 
     to an individual enrolled under 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 (c)) for such item or service.
       ``(B) If such provider is not a participating provider with 
     respect to such item or service, the maximum allowed amount 
     or other dollar amount 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.
       ``(C) The estimated amount of cost sharing (including 
     deductibles, copayments, and coinsurance) that the individual 
     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 maximum 
     allowed amount or other dollar amount described in such 
     subparagraph).
       ``(D) The amount the individual 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 individuals 
     enrolled in the plan or coverage, by such separate 
     deductibles or maximums, in addition to any cumulative 
     deductible or maximum).
       ``(E) 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 
     individual has accrued towards such limitation with respect 
     to such item or service.
       ``(F) Any prior authorization, concurrent review, step 
     therapy, fail first, or similar requirements applicable to 
     coverage of such item or service under such plan or coverage.
       ``(G) Any shared savings (such as any credit, payment, or 
     other benefit provided by such plan or issuer) available to 
     the individual with respect to such item or service furnished 
     by such provider known at the time such request is made.
       ``(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 (or successor 
     technology specified 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 timely and 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; or
       ``(ii) all providers that are participating providers with 
     respect to such item or service;
       ``(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; and
       ``(F) meets any other requirement determined appropriate by 
     the Secretary to ensure the accessibility and usability of 
     information provided through such tool.
     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 similar items and services.
       ``(b) Rate and Payment Information.--
       ``(1) In general.--For plan years beginning on or after 
     January 1, 2026, each group health plan and health insurance 
     issuer offering group or individual health insurance coverage 
     (other than a grandfathered health plan (as defined in 
     section 1251(e) of the Patient Protection and Affordable Care 
     Act)) shall, for each month, not later than the tenth day of 
     such month, make available to the public the rate and payment 
     information described in paragraph (2) in accordance with 
     paragraph (3).
       ``(2) Rate and payment information described.--For purposes 
     of paragraph (1), the rate and payment information described 
     in this paragraph is, with respect to a group health plan or 
     group or individual health insurance coverage, 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 (expressed as a dollar amount) 
     in effect as of the date on which such information is made 
     public with each provider that is a participating provider 
     with respect to such item or service.
       ``(B) With respect to each drug (identified by national 
     drug code) for which benefits are available under such plan 
     or coverage--
       ``(i) the in-network rate (expressed as a dollar amount) in 
     effect as of the first day of the month in which such 
     information is made public with each provider that is a 
     participating provider with respect to such drug; 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 publication to each provider 
     that was a participating provider with respect to such drug, 
     broken down by each such provider, 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, 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.
       ``(3) Manner of publication.--Rate and payment information 
     required to be made available under this subsection shall be 
     so made available in dollar amounts through separate machine-
     readable files (and any successor technology, such as 
     application program interface technology, determined 
     appropriate by the Secretary) corresponding to the 
     information described in each of subparagraphs (A) through 
     (C) of paragraph (2) that meet such requirements as specified 
     by the Secretary through subregulatory guidance. Such 
     requirements shall ensure that such files are limited to an 
     appropriate size, do not include disclosure of unnecessary 
     duplicative information contained in other files made 
     available under this subsection, are made available in a 
     widely-available format through a publicly-available website 
     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.
       ``(4) User instructions.--Each group health plan and health 
     insurance issuer offering group or individual health 
     insurance coverage shall make available to the public 
     instructions written in plain language explaining how 
     individuals may search for information described in paragraph 
     (2) in files submitted in accordance with paragraph (3). The 
     Secretary shall develop and publish through subregulatory 
     guidance a template that such a plan may use in developing 
     instructions for purposes of the preceding sentence.
       ``(5) Summary.--For each plan year beginning on or after 
     January 1, 2026, each group health plan and health insurance 
     issuer offering group or individual health insurance coverage 
     shall make public a data file, in a manner that ensures that 
     such file may be easily downloaded and read by standard 
     spreadsheet software and that meets such requirements as 
     established by the Secretary, 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 plan 
     year. Such file shall include the following:
       ``(A) The mean, median, and interquartile range of the in-
     network rate, and the amount allowed for an item or service 
     when not furnished by a participating provider, in effect as 
     of the first day of such plan year for each item or service 
     (identified by payer

[[Page H6770]]

     identifier approved or used by the Centers for Medicare & 
     Medicaid Services) for which benefits are available under the 
     plan or coverage, broken down by the type of provider 
     furnishing the item or service and by the geographic area in 
     which such item or service is furnished.
       ``(B) Trends in payment rates for such items and services 
     over such plan year, including an identification of instances 
     in which such rates have increased, decreased, or remained 
     the same.
       ``(C) The name of such plan, a description of the type of 
     network of participating providers used by such plan or 
     coverage, and, in the case of a group health plan, a 
     description of whether such plan is self-insured or fully-
     insured.
       ``(D) For each item or service which is paid as part of a 
     bundled rate--
       ``(i) a description of the formulae, pricing methodologies, 
     or other information used to calculate the payment rate for 
     such bundle; and
       ``(ii) a list of the items and services included in such 
     bundle.
       ``(E) The percentage of items and services that are paid 
     for on a fee-for-service basis and the percentage of items 
     and services that are paid for as part of a bundled rate, 
     capitated payment rate, or other alternative payment model.
       ``(6) Attestation.--Each group health plan and health 
     insurance issuer offering group or individual health 
     insurance coverage shall post, along with rate and payment 
     information made public by such plan or issuer, an 
     attestation that such information is complete and accurate.
       ``(c) Accessibility.--A group health plan and a health 
     insurance issuer offering group or individual health 
     insurance coverage shall take reasonable steps (as specified 
     by the Secretary) to ensure that information provided in 
     response to a request described in subsection (a), and rate 
     and payment information made public under subsection (b), is 
     provided in plain, easily understandable language and that 
     interpretation, translations, and assistive services are 
     provided to those with limited English proficiency and those 
     with disabilities.
       ``(d) Definitions.--In this section:
       ``(1) Participating provider.--The term `participating 
     provider' means, with respect to an item or service and a 
     group health plan or health insurance issuer offering group 
     or individual health insurance coverage, a physician or other 
     health care provider who is acting within the scope of 
     practice of that provider's license or certification under 
     applicable State law and who has a contractual relationship 
     with the plan or issuer, respectively, for furnishing such 
     item or service under the plan or coverage, and includes 
     facilities, respectively.
       ``(2) Provider.--The term `provider' includes a health care 
     facility.
       ``(3) 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, 
     regardless of whether such rate is calculated based on a set 
     amount, a fee schedule, or an amount derived from another 
     amount, or a formula, or other method.''.
       (3) 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. TRANSPARENCY IN COVERAGE.

       ``(a) Cost-Sharing Transparency.--
       ``(1) In general.--For plan years beginning on or after 
     January 1, 2026, a group health plan and a health insurance 
     issuer offering group health insurance coverage shall permit 
     a participant or beneficiary to learn the amount of cost-
     sharing (including deductibles, copayments, and coinsurance) 
     under the participant 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 in a timely manner upon the request of 
     the participant or beneficiary. At a minimum, such 
     information shall include the information specified in 
     paragraph (2) and shall be made available to such participant 
     or beneficiary through a self-service tool that meets the 
     requirements of paragraph (3) or, at the option of such 
     participant or beneficiary, through a paper disclosure or 
     phone or other electronic disclosure (as selected by such 
     participant or beneficiary and provided at no cost to such 
     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 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 (c)) for such item or service.
       ``(B) If such provider is not a participating provider with 
     respect to such item or service, the maximum allowed amount 
     or other dollar amount that such plan or coverage will 
     recognize as payment for such item or service, along with a 
     notice that such participant or beneficiary may be liable for 
     additional charges.
       ``(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 maximum allowed amount or other 
     dollar amount described in such subparagraph).
       ``(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) 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.
       ``(F) Any prior authorization, concurrent review, step 
     therapy, fail first, or similar requirements applicable to 
     coverage of such item or service under such plan or coverage.
       ``(G) Any shared savings (such as any credit, payment, or 
     other benefit provided by such plan or issuer) available to 
     the participant or beneficiary with respect to such item or 
     service furnished by such provider known at the time such 
     request is made.
       ``(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 (or successor 
     technology specified 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 timely and 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; or
       ``(ii) all providers that are participating providers with 
     respect to such item or service;
       ``(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; and
       ``(F) meets any other requirement determined appropriate by 
     the Secretary to ensure the accessibility and usability of 
     information provided through such tool.
     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 similar items and services.
       ``(b) Rate and Payment Information.--
       ``(1) In general.--For plan years beginning on or after 
     January 1, 2026, each group health plan and health insurance 
     issuer offering group health insurance coverage (other than a 
     grandfathered health plan (as defined in section 1251(e) of 
     the Patient Protection and Affordable Care Act)) shall, for 
     each month, not later than the tenth day of such month, make 
     available to the public the rate and payment information 
     described in paragraph (2) in accordance with paragraph (3).
       ``(2) Rate and payment information described.--For purposes 
     of paragraph (1), the rate and payment information described 
     in this paragraph is, with respect to a group health plan or 
     group health insurance coverage, 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 (expressed as a dollar amount) 
     in effect as of the date on which such information is made 
     public with each provider that is a participating provider 
     with respect to such item or service.
       ``(B) With respect to each drug (identified by national 
     drug code) for which benefits are available under such plan 
     or coverage--
       ``(i) the in-network rate (expressed as a dollar amount) in 
     effect as of the first day of the month in which such 
     information is made public with each provider that is a 
     participating provider with respect to such drug; 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 publication to each provider 
     that was a participating provider with respect to such drug, 
     broken down by each such provider, 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, 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

[[Page H6771]]

     with respect to such item or service, broken down by each 
     such provider.
       ``(3) Manner of publication.--Rate and payment information 
     required to be made available under this subsection shall be 
     so made available in dollar amounts through separate machine-
     readable files (and any successor technology, such as 
     application program interface technology, determined 
     appropriate by the Secretary) corresponding to the 
     information described in each of subparagraphs (A) through 
     (C) of paragraph (2) that meet such requirements as specified 
     by the Secretary through subregulatory guidance. Such 
     requirements shall ensure that such files are limited to an 
     appropriate size, do not include disclosure of unnecessary 
     duplicative information contained in other files made 
     available under this subsection, are made available in a 
     widely available format through a publicly available website 
     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.
       ``(4) User instructions.--Each group health plan and health 
     insurance issuer offering group health insurance coverage 
     shall make available to the public instructions written in 
     plain language explaining how individuals may search for 
     information described in paragraph (2) in files submitted in 
     accordance with paragraph (3). The Secretary shall develop 
     and publish through subregulatory guidance a template that 
     such a plan may use in developing instructions for purposes 
     of the preceding sentence.
       ``(5) Summary.--For each plan year beginning on or after 
     January 1, 2026, each group health plan and health insurance 
     issuer offering group health insurance coverage shall make 
     public a data file, in a manner that ensures that such file 
     may be easily downloaded and read by standard spreadsheet 
     software and that meets such requirements as established by 
     the Secretary, 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 plan year. Such file 
     shall include the following:
       ``(A) The mean, median, and interquartile range of the in-
     network rate, and the amount allowed for an item or service 
     when not furnished by a participating provider, in effect as 
     of the first day of such plan year for each item or service 
     (identified by payer identifier approved or used by the 
     Centers for Medicare & Medicaid Services) for which benefits 
     are available under the plan or coverage, broken down by the 
     type of provider furnishing the item or service and by the 
     geographic area in which such item or service is furnished.
       ``(B) Trends in payment rates for such items and services 
     over such plan year, including an identification of instances 
     in which such rates have increased, decreased, or remained 
     the same.
       ``(C) The name of such plan, a description of the type of 
     network of participating providers used by such plan or 
     coverage, and, in the case of a group health plan, a 
     description of whether such plan is self-insured or fully-
     insured.
       ``(D) For each item or service which is paid as part of a 
     bundled rate--
       ``(i) a description of the formulae, pricing methodologies, 
     or other information used to calculate the payment rate for 
     such bundle; and
       ``(ii) a list of the items and services included in such 
     bundle.
       ``(E) The percentage of items and services that are paid 
     for on a fee-for-service basis and the percentage of items 
     and services that are paid for as part of a bundled rate, 
     capitated payment rate, or other alternative payment model.
       ``(6) Attestation.--Each group health plan and health 
     insurance issuer offering group health insurance coverage 
     shall post, along with rate and payment information made 
     public by such plan or issuer, an attestation that such 
     information is complete and accurate.
       ``(c) Accessibility.--A group health plan and a health 
     insurance issuer offering group health insurance coverage 
     shall take reasonable steps (as specified by the Secretary) 
     to ensure that information provided in response to a request 
     described in subsection (a), and rate and payment information 
     made public under subsection (b), is provided in plain, 
     easily understandable language and that interpretation, 
     translations, and assistive services are provided to those 
     with limited English proficiency and those with disabilities.
       ``(d) Definitions.--In this section:
       ``(1) Participating provider.--The term `participating 
     provider' means, with respect to an item or service and a 
     group health plan or health insurance issuer offering group 
     or individual health insurance coverage, a physician or other 
     health care provider who is acting within the scope of 
     practice of that provider's license or certification under 
     applicable State law and who has a contractual relationship 
     with the plan or issuer, respectively, for furnishing such 
     item or service under the plan or coverage, and includes 
     facilities, respectively.
       ``(2) Provider.--The term `provider' includes a health care 
     facility.
       ``(3) 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, regardless of 
     whether such rate is calculated based on a set amount, a fee 
     schedule, or an amount derived from another amount, or a 
     formula, or other method.''.
       (B) Clerical amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 is 
     amended by striking the item relating to section 719 and 
     inserting the following new item:

``Sec. 719. Transparency in coverage.''.
       (b) Application Programming Interface Report.--Not later 
     than January 1, 2025, and annually thereafter, the Secretary 
     of Health and Human Services shall, in consultation with the 
     Office of the National Coordinator for Health Information 
     Technology, Department of Labor, the Department of the 
     Treasury, and stakeholders, submit to the House Committees on 
     Education and the Workforce, Energy and Commerce, and Ways 
     and Means, and the Senate Committees on Finance and Health, 
     Education, Labor, and Pensions a report on the use of 
     standards-based application programming interfaces (in this 
     subsection referred to as ``APIs'') to facilitate access to 
     health care price transparency information and the 
     interoperability of other medical information. Such report 
     shall include an evaluation of the capacity of the Department 
     of Health and Human Services, the Department of Labor, and 
     the Department of the Treasury to regulate and implement 
     standards related to APIs and recommendations for improving 
     such capacity. Such report shall include the following:
       (1) A description of current use, and proposed use, of APIs 
     under Federal rules to facilitate interoperability, including 
     information related to capacity constraints within the 
     agencies, barriers to adoption, privacy and security, 
     administrative burdens and efficiencies, care coordination, 
     and levels of compliance.
       (2) A description of the feasibility of agency 
     participation in the development of APIs to enable 
     application access to price transparency data under the 
     amendments made by subsection (a).
       (3) A specification of the timeline for which such data 
     standards can be required to make such data accessible via an 
     API.
       (4) An analysis of the benefits and challenges of 
     implementing standards-based APIs for price transparency 
     data, including the ability for consumers to access rate and 
     payment information and the amount of cost-sharing (including 
     deductibles, copayments, and coinsurance) under the 
     consumer's plan through third-party internet-based tools and 
     applications.
       (5) An analysis of the impact that APIs which provide real-
     time access to pricing and cost-sharing information may have 
     in increasing the amount of services shoppable for 
     individuals, such as by standardizing more health care spend 
     via episode bundles.
       (6) An analysis of which health care items and services may 
     be useful under API, such as those for which prices change 
     with the greatest frequency.
       (7) An analysis of the cost of API standards implementation 
     on issuers, employers, and other private-sector entities.
       (8) An analysis of the ability of State regulators to 
     enforce API standards and the costs to the Federal Government 
     and States to regulate and enforce API standards.
       (9) An analysis of the interaction with API standards and 
     Federal health information privacy standards.
       (c) Provider Tool Report.--
       (1) In general.--Not later than 1 year after the date of 
     the enactment of this Act, The Secretary of Health and Human 
     Services, acting through the Administrator of the Centers for 
     Medicare & Medicaid Services, shall, in consultation with 
     stakeholders, conduct a study and submit to the House 
     Committees on Education and the Workforce, Energy and 
     Commerce, and Ways and Means, and the Senate Committees on 
     Finance and Health, Education, Labor, and Pensions a report 
     on the usefulness and feasibility of the establishment of a 
     provider tool by a group health plan, or a health insurance 
     issuer offering group and individual health insurance 
     coverage, in facilitating the provision of information made 
     available pursuant to the amendments made by subsection (a). 
     Such report shall include the following:
       (A) A description of the feasibility of establishing a 
     requirement for the various types of plans and coverage to 
     offer such a provider tool, including any challenges to 
     establishing a provider tool using the same technology 
     platform as the self-service tool described in such 
     amendments.
       (B) An evaluation on the usefulness of a provider tool to 
     aid patient-decision making and how such tool would 
     coordinate with other information available to a patient and 
     their provider under other Federal requirements in place or 
     under consideration.
       (C) An evaluation of whether the information provided by 
     such tool would be duplicative of the advanced explanation of 
     benefits required under Federal law or any other existing 
     requirement.
       (D) A description of the usability and expected utilization 
     of such tool among providers, including among different 
     provider types.
       (E) An analysis of the impact of a provider tool in value-
     based care arrangements.

[[Page H6772]]

       (F) An analysis on the potential impact of the provider 
     tool on--
       (i) patients' out-of-pocket spending;
       (ii) plan design, including impacts on cost-sharing 
     requirements;
       (iii) care coordination and quality;
       (iv) plan premiums;
       (v) overall health care spending and utilization; and
       (vi) health care access in rural areas.
       (G) An analysis of the feasibility of a provider tool to 
     include additional functionality to facilitate and improve 
     the administration of the requirements on providers to submit 
     notifications to such plan or coverage under section 2799B-6 
     of the Public Health Service Act and the requirements on such 
     plan or coverage to provide an advanced explanation of 
     benefits to individuals under section 2799A-1(f) of such Act.
       (H) An analysis of which health care items and services, 
     would be most useful for patients utilizing a provider tool.
       (I) An analysis of rulemaking required to ensure such a 
     tool complies with federal health information privacy 
     standards.
       (J) An analysis of the burden and cost of the creation of a 
     provider tool by plans and coverage on providers, issuers, 
     employers, and other private-sector entities.
       (K) An analysis of the ability of state regulators to 
     enforce provider tool standards and the costs to the 
     Department and states to regulate and enforce provider tool 
     standards.
       (2) Definition.--The term ``provider tool'' means a tool 
     designed to facilitate the provision of information made 
     available pursuant to the amendments made by subsection (a) 
     and established by a group health plan or a health insurance 
     issuer offering group and individual health insurance 
     coverage that allows providers to access the information such 
     plan or coverage must provide through the self-service tool 
     described in such amendments to an individual with whom the 
     provider is actively treating at the time of such request, 
     upon the request of the provider, and with the consent of 
     such individual.
       (d) Reports.--
       (1) Compliance.--Not later than January 1, 2027, the 
     Comptroller General of the United States shall submit to 
     Congress a report containing--
       (A) an analysis of compliance with the amendments made by 
     this section;
       (B) an analysis of enforcement of such amendments by the 
     Secretaries of Health and Human Services, Labor, and the 
     Treasury;
       (C) recommendations relating to improving such enforcement; 
     and
       (D) recommendations relating to improving public 
     disclosure, and public awareness, of information required to 
     be made available by group health plans and health insurance 
     issuers pursuant to such amendments.
       (2) Prices.--Not later than January 1, 2028, and biennially 
     thereafter, the Secretaries of Health and Human Services, 
     Labor, and the Treasury shall jointly submit to Congress a 
     report containing an assessment of differences in negotiated 
     prices (and any trends in such prices) in the private market 
     between--
       (A) rural and urban areas;
       (B) the individual, small group, and large group markets;
       (C) consolidated and nonconsolidated health care provider 
     areas (as specified by the Secretary of Health and Human 
     Services);
       (D) nonprofit and for-profit hospitals;
       (E) nonprofit and for-profit insurers; and
       (F) insurers serving local or regional areas and insurers 
     serving multistate or national areas.
       (e) Quality Report.--Not later than 1 year after the date 
     of enactment of this subsection, the Secretaries of Health 
     and Human Services, Labor, and the Treasury shall jointly 
     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.
       (f) 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 any plan year beginning before January 1, 2026.

     SEC. 106. PHARMACY BENEFITS PRICE TRANSPARENCY.

       (a) PHSA.--Title XXVII of the Public Health Service Act (42 
     U.S.C. 300gg et seq.) is amended--
       (1) in part D (42 U.S.C. 300gg-111 et seq.), 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 the 
     date that is 2 years after the date of enactment of this 
     section, a group health plan or a health insurance issuer 
     offering group health insurance coverage, or an entity or 
     subsidiary providing pharmacy benefits management services on 
     behalf of such a plan or issuer, shall not enter into a 
     contract with a drug manufacturer, distributor, wholesaler, 
     subcontractor, rebate aggregator, or any other third party 
     that limits (or delays beyond the applicable reporting period 
     described in subsection (b)(1)) the disclosure of information 
     to group health plans in such a manner that prevents such 
     plan, issuer, or entity from making the reports described in 
     subsection (b).
       ``(b) Reports.--
       ``(1) In general.--With respect to plan years beginning on 
     or after the date that is 2 years after the date of enactment 
     of this section, not less frequently than every 6 months (or 
     at the request of a group health plan, not less frequently 
     than quarterly, but under the same conditions, terms, and 
     cost of the semiannual report under this subsection), a group 
     health plan or health insurance issuer offering group health 
     insurance coverage, or an entity providing pharmacy benefits 
     management services on behalf of such a plan or issuer, shall 
     submit to the group health plan a report in accordance with 
     this section. Each such report shall be made available to 
     such group health plan in a machine-readable format and shall 
     include the information described in paragraph (2).
       ``(2) Information described.--For purposes of paragraph 
     (1), the information described in this paragraph is, with 
     respect to drugs covered by a group health plan or health 
     insurance issuer offering group health insurance coverage 
     during each reporting period--
       ``(A) in the case of such a plan offered by a specified 
     large employer (or such coverage offered in connection with 
     such a plan offered by a specified large employer)--
       ``(i) a list of drugs for which a claim was filed and, with 
     respect to each such drug on such list--

       ``(I) the brand name, chemical entity, and National Drug 
     Code;
       ``(II) the type of dispensing channel used to furnish such 
     drug, including retail, mail order, or specialty pharmacy;
       ``(III) with respect to each drug dispensed under each type 
     of dispensing channel (including retail, mail order, or 
     specialty pharmacy)--

       ``(aa) whether such drug is a brand name drug or a generic 
     drug, and--
       ``(AA) in the case of a brand name drug, the wholesale 
     acquisition cost, listed as cost per days supply and cost per 
     dosage unit, on the date such drug was dispensed; and
       ``(BB) in the case of a generic drug, the average wholesale 
     price, listed as cost per days supply and cost per dosage 
     unit, on the date such drug was dispensed; and
       ``(bb) the total number of--
       ``(AA) prescription claims (including original 
     prescriptions and refills);
       ``(BB) participants, beneficiaries, and enrollees for whom 
     a claim for such drug was filed;
       ``(CC) dosage units per fill of such drug; and
       ``(DD) days supply of such drug per fill;

       ``(IV) the net price per course of treatment or single 
     fill, such as a 30-day supply or 90-day supply to the plan or 
     coverage after manufacturer rebates, fees, and other 
     remuneration or adjustments;
       ``(V) the total amount of out-of-pocket spending by 
     participants, beneficiaries, and enrollees on such drug, 
     including spending through copayments, coinsurance, and 
     deductibles;
       ``(VI) the total net spending by the plan or coverage 
     during the reporting period;
       ``(VII) the total amount received, or expected to be 
     received, by the plan or coverage from any entity in drug 
     manufacturer rebates, fees, alternative discounts, and all 
     other remuneration received from an entity or any third party 
     (including group purchasing organizations) other than the 
     plan sponsor;
       ``(VIII) the total amount received, or expected to be 
     received by the plan or issuer, from drug manufacturers in 
     rebates, fees, alternative discounts, or other remuneration--

       ``(aa) that has been paid, or is to be paid, by drug 
     manufacturers for claims incurred during the reporting 
     period; and
       ``(bb) that is related to utilization rebates for such 
     drug; and

       ``(IX) to the extent feasible, information on the total 
     amount of remuneration, including copayment assistance 
     dollars paid, copayment cards applied, or other discounts 
     provided by each drug manufacturer (or entity administering 
     copay assistance on behalf of such drug manufacturer) to the 
     participants, beneficiaries, and enrollees enrolled in such 
     plan or coverage for such drug;

       ``(ii) for each category or class of drugs for which a 
     claim was filed, a breakdown of the total gross spending on 
     drugs in such category or class before rebates, price 
     concessions, alternative discounts, or other remuneration 
     from drug manufacturers, and the net spending after such 
     rebates, price concessions, alternative discounts, or other 
     remuneration from drug manufacturers, including--

       ``(I) the number of participants, beneficiaries, and 
     enrollees who filled a prescription for a drug in such 
     category or class, including the National Drug Code for each 
     such drug;
       ``(II) if applicable, a description of the formulary tiers 
     and utilization mechanisms (such as prior authorization or 
     step therapy) employed for drugs in that category or class; 
     and
       ``(III) the total out-of-pocket spending under the plan or 
     coverage by participants, beneficiaries, and enrollees, 
     including spending through copayments, coinsurance, and 
     deductibles;

       ``(iii) in the case of a drug for which gross spending by 
     such plan, coverage, or entity

[[Page H6773]]

     exceeded $10,000 during the reporting period--

       ``(I) a list of all other drugs in the same therapeutic 
     category or class; and
       ``(II) the rationale for the formulary placement of such 
     drug in that therapeutic category or class, if applicable; 
     and

       ``(iv) in the case such plan or coverage (or an entity 
     providing pharmacy benefits management services on behalf of 
     such plan or coverage) has an affiliated pharmacy or pharmacy 
     under common ownership--

       ``(I) the percentage of total prescriptions dispensed by 
     such pharmacies to individuals enrolled in such plan or 
     coverage;
       ``(II) a list of all drugs dispensed by such pharmacies to 
     individuals enrolled in such plan or coverage, and, with 
     respect to each drug dispensed--

       ``(aa) the amount charged, per dosage unit, per 30-day 
     supply, or per 90-day supply (as applicable) to the plan or 
     issuer, and to participants, beneficiaries, and enrollees 
     enrolled in such plan or coverage;
       ``(bb) the median amount charged to such plan or issuer, 
     and the interquartile range of the costs, per dosage unit, 
     per 30-day supply, and per 90-day supply, including amounts 
     paid by the participants, beneficiaries, and enrollees, 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;
       ``(cc) the lowest cost per dosage unit, per 30-day supply 
     and per 90-day supply, for each such drug, including amounts 
     charged to the plan and participants, beneficiaries, and 
     enrollees, that is available from any pharmacy included in 
     the network of such plan or coverage; and
       ``(dd) the net acquisition cost per dosage unit, per 30-day 
     supply, and per 90-day supply, if such drug is subject to a 
     maximum price discount;
       ``(B) in the case of a plan or coverage not described in 
     subparagraph (A)--
       ``(i) the total net spending by the plan or coverage for 
     all drugs covered by such plan or coverage during such 
     reporting period;
       ``(ii) the total amount received, or expected to be 
     received, by the plan or coverage from any entity in drug 
     manufacturer rebates, fees, alternative discounts, and all 
     other remuneration received from an entity or any third party 
     (including group purchasing organizations) other than the 
     plan sponsor for all such drugs; and
       ``(iii) to the extent feasible, information on the total 
     amount of remuneration, including copayment assistance 
     dollars paid, copayment cards applied, or other discounts 
     provided by each drug manufacturer (or entity administering 
     copay assistance on behalf of such drug manufacturer) to the 
     participants, beneficiaries, and enrollees enrolled in such 
     plan or coverage for such drugs;
       ``(C) 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) to 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 an entity 
     providing pharmacy benefits management services, including 
     the identity of the recipient of such amounts;
       ``(D) an explanation of any benefit design parameters that 
     encourage or require participants, beneficiaries, and 
     enrollees in such 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 directly or indirectly 
     funded by such entity; and
       ``(E) total gross spending on all drugs during the 
     reporting period.
       ``(3) Privacy requirements.--
       ``(A) In general.--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 13402(a) 
     of the Health Information Technology for Clinical Health Act 
     and consistent with the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act) and shall 
     restrict the use and disclosure of such information according 
     to such privacy, security, and breach notification 
     regulations and such HIPAA privacy regulations.
       ``(B) Additional requirements.--
       ``(i) In general.--An entity providing pharmacy benefits 
     management services on behalf of a group health plan or 
     health insurance issuer offering group health insurance 
     coverage that submits a report under paragraph (1) shall 
     ensure that such report contains only summary health 
     information, as defined in section 164.504(a) of title 45, 
     Code of Federal Regulations (or successor regulations).
       ``(ii) Restrictions.--A group health plan shall comply with 
     section 164.504(f) of title 45, Code of Federal Regulations 
     (or a successor regulation) and a plan sponsor shall act in 
     accordance with the terms of the agreement described in such 
     section.
       ``(C) Rule of construction.--Nothing in this section shall 
     be construed to modify the requirements for the creation, 
     receipt, maintenance, or transmission of protected health 
     information under the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act).
       ``(4) Disclosure and redisclosure.--
       ``(A) Limitation to business associates.--A group health 
     plan receiving a report under paragraph (1) may disclose such 
     information only to the entity from which the report was 
     received or to that entity's business associates as defined 
     in section 160.103 of title 45, Code of Federal Regulations 
     (or successor regulations) or as permitted by the HIPAA 
     Privacy Rule (45 CFR parts 160 and 164, subparts A and E).
       ``(B) Clarification regarding public disclosure of 
     information.--Nothing in this section shall prevent a group 
     health plan or health insurance issuer offering group health 
     insurance coverage, or an entity providing pharmacy benefits 
     management services on behalf of such a plan or coverage, 
     from placing reasonable restrictions on the public disclosure 
     of the information contained in a report described in 
     paragraph (1), except that such plan, 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, or the Comptroller General of the 
     United States.
       ``(C) Limited form of report.--The Secretary shall define 
     through rulemaking a limited form of the report under 
     paragraph (1) required with respect to group health plans 
     where the plan sponsors of such plans are drug manufacturers, 
     drug wholesalers, or other direct participants in the drug 
     supply chain, in order to prevent anti-competitive behavior.
       ``(5) Report to gao.--A group health plan or health 
     insurance issuer offering group health insurance coverage, or 
     an entity providing pharmacy benefits management services on 
     behalf of such plan or coverage, shall submit to the 
     Comptroller General of the United States each of the first 4 
     reports submitted to a group health plan under paragraph (1) 
     and other such reports as requested, in accordance with the 
     privacy requirements under paragraph (3), the disclosure and 
     redisclosure standards under paragraph (4), the standards 
     specified pursuant to paragraph (6), and such other 
     information that the Comptroller General determines necessary 
     to carry out the study under section 106(d) of the Lower 
     Costs, More Transparency Act.
       ``(6) Standard format.--Not later than 1 year after the 
     date of enactment of this section, the Secretary shall 
     specify through rulemaking standards for group health plans, 
     health insurance issuers offering group health insurance 
     coverage, and entities providing pharmacy benefits management 
     services on behalf of such plans or coverage, required to 
     submit reports under paragraph (1) to submit such reports in 
     a standard format.
       ``(c) Enforcement.--
       ``(1) In general.--The Secretary shall enforce this 
     section.
       ``(2) Failure to provide information.--A health insurance 
     issuer or an entity providing pharmacy benefits management 
     services on behalf of such plan or coverage that violates 
     sub-section (a) or fails to provide the 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.
       ``(3) False information.--A health insurance issuer or an 
     entity providing pharmacy benefits management services on 
     behalf of such a plan or coverage 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.
       ``(4) Procedure.--The provisions of section 1128A of the 
     Social Security Act, other than subsections (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 such section.
       ``(5) 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 the requirements in this section.
       ``(d) Rule of Construction.--Nothing in this section shall 
     be construed to permit a group health plan, health insurance 
     issuer, or entity providing pharmacy benefits management 
     services on behalf of such plan or coverage, 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) or (b) by entities subject to such 
     subsection.
       ``(e) Definitions.--In this section:
       ``(1) Specified large employer.--The term `specified 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

[[Page H6774]]

       (2) in section 2723 (42 U.S.C. 300gg-22)--
       (A) in subsection (a)--
       (i) in paragraph (1), by inserting ``(other than 
     subsections (a) and (b) of section 2799A-11)'' after ``part 
     D''; and
       (ii) in paragraph (2), by inserting ``(other than 
     subsections (a) and (b) of section 2799A-11)'' after ``part 
     D''; and
       (B) in subsection (b)--
       (i) in paragraph (1), by inserting ``(other than 
     subsections (a) and (b) of section 2799A-11)'' after ``part 
     D'';
       (ii) in paragraph (2)(A), by inserting ``(other than 
     subsections (a) and (b) of section 2799A-11)'' after ``part 
     D''; and
       (iii) in paragraph (2)(C)(ii), by inserting ``(other than 
     subsections (a) and (b) of section 2799A-11)'' after ``part 
     D''.
       (b) 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 BENEFIT MANAGER SERVICES.

       ``(a) In General.--For plan years beginning on or after the 
     date that is 2 years after the date of enactment of this 
     section, a group health plan or a health insurance issuer 
     offering group health insurance coverage, or an entity or 
     subsidiary providing pharmacy benefits management services on 
     behalf of such a plan or issuer, shall not enter into a 
     contract with a drug manufacturer, distributor, wholesaler, 
     subcontractor, rebate aggregator, or any other third party 
     that limits (or delays beyond the applicable reporting period 
     described in subsection (b)(1)) the disclosure of information 
     to group health plans in such a manner that prevents such 
     plan, issuer, or entity from making the reports described in 
     subsection (b).
       ``(b) Reports.--
       ``(1) In general.--With respect to plan years beginning on 
     or after the date that is 2 years after the date of enactment 
     of this section, not less frequently than every 6 months (or 
     at the request of a group health plan, not less frequently 
     than quarterly, but under the same conditions, terms, and 
     cost of the semiannual report under this subsection), a group 
     health plan or health insurance issuer offering group health 
     insurance coverage, or an entity providing pharmacy benefits 
     management services on behalf of such a plan or issuer, shall 
     submit to the group health plan a report in accordance with 
     this section. Each such report shall be made available to 
     such group health plan in a machine-readable format and shall 
     include the information described in paragraph (2).
       ``(2) Information described.--For purposes of paragraph 
     (1), the information described in this paragraph is, with 
     respect to drugs covered by a group health plan or health 
     insurance issuer offering group health insurance coverage 
     during each reporting period--
       ``(A) in the case of such a plan offered by a specified 
     large employer (or such coverage offered in connection with 
     such a plan offered by a specified large employer)--
       ``(i) a list of drugs for which a claim was filed and, with 
     respect to each such drug on such list--

       ``(I) the brand name, chemical entity, and National Drug 
     Code;
       ``(II) the type of dispensing channel used to furnish such 
     drug, including retail, mail order, or specialty pharmacy;
       ``(III) with respect to each drug dispensed under each type 
     of dispensing channel (including retail, mail order, or 
     specialty pharmacy)--

       ``(aa) whether such drug is a brand name drug or a generic 
     drug, and--
       ``(AA) in the case of a brand name drug, the wholesale 
     acquisition cost, listed as cost per days supply and cost per 
     dosage unit, on the date such drug was dispensed; and
       ``(BB) in the case of a generic drug, the average wholesale 
     price, listed as cost per days supply and cost per dosage 
     unit, on the date such drug was dispensed; and
       ``(bb) the total number of--
       ``(AA) prescription claims (including original 
     prescriptions and refills);
       ``(BB) participants and beneficiaries for whom a claim for 
     such drug was filed;
       ``(CC) dosage units per fill of such drug; and
       ``(DD) days supply of such drug per fill;

       ``(IV) the net price per course of treatment or single 
     fill, such as a 30-day supply or 90-day supply to the plan or 
     coverage after manufacturer rebates, fees, and other 
     remuneration or adjustments;
       ``(V) the total amount of out-of-pocket spending by 
     participants, beneficiaries, and enrollees on such drug, 
     including spending through copayments, coinsurance, and 
     deductibles;
       ``(VI) the total net spending by the plan or coverage 
     during the reporting period;
       ``(VII) the total amount received, or expected to be 
     received, by the plan or coverage from any entity in drug 
     manufacturer rebates, fees, alternative discounts, and all 
     other remuneration received from an entity or any third party 
     (including group purchasing organizations) other than the 
     plan sponsor;
       ``(VIII) the total amount received, or expected to be 
     received by the plan or issuer, from drug manufacturers in 
     rebates, fees, alternative discounts, or other remuneration--

       ``(aa) that has been paid, or is to be paid, by drug 
     manufacturers for claims incurred during the reporting 
     period; and
       ``(bb) that is related to utilization rebates for such 
     drug; and

       ``(IX) to the extent feasible, information on the total 
     amount of remuneration, including copayment assistance 
     dollars paid, copayment cards applied, or other discounts 
     provided by each drug manufacturer (or entity administering 
     copay assistance on behalf of such drug manufacturer) to the 
     participants, beneficiaries, and enrollees enrolled in such 
     plan or coverage for such drug;

       ``(ii) for each category or class of drugs for which a 
     claim was filed, a breakdown of the total gross spending on 
     drugs in such category or class before rebates, price 
     concessions, alternative discounts, or other remuneration 
     from drug manufacturers, and the net spending after such 
     rebates, price concessions, alternative discounts, or other 
     remuneration from drug manufacturers, including--

       ``(I) the number of participants, beneficiaries, and 
     enrollees who filled a prescription for a drug in such 
     category or class, including the National Drug Code for each 
     such drug;
       ``(II) if applicable, a description of the formulary tiers 
     and utilization mechanisms (such as prior authorization or 
     step therapy) employed for drugs in that category or class; 
     and
       ``(III) the total out-of-pocket spending under the plan or 
     coverage by participants, beneficiaries, and enrollees, 
     including spending through copayments, coinsurance, and 
     deductibles;

       ``(iii) in the case of a drug for which gross spending by 
     such plan, coverage, or entity exceeded $10,000 during the 
     reporting period--

       ``(I) a list of all other drugs in the same therapeutic 
     category or class; and
       ``(II) the rationale for the formulary placement of such 
     drug in that therapeutic category or class, if applicable; 
     and

       ``(iv) in the case such plan or coverage (or an entity 
     providing pharmacy benefits management services on behalf of 
     such plan or coverage) has an affiliated pharmacy or pharmacy 
     under common ownership--

       ``(I) the percentage of total prescriptions dispensed by 
     such pharmacies to individuals enrolled in such plan or 
     coverage;
       ``(II) a list of all drugs dispensed by such pharmacies to 
     individuals enrolled in such plan or coverage, and, with 
     respect to each drug dispensed--

       ``(aa) the amount charged, per dosage unit, per 30-day 
     supply, or per 90-day supply (as applicable) to the plan or 
     issuer, and to participants, beneficiaries, and enrollees 
     enrolled in such plan or coverage;
       ``(bb) the median amount charged to such plan or issuer, 
     and the interquartile range of the costs, per dosage unit, 
     per 30-day supply, and per 90-day supply, including amounts 
     paid by the participants, beneficiaries, and enrollees, 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;
       ``(cc) the lowest cost per dosage unit, per 30-day supply 
     and per 90-day supply, for each such drug, including amounts 
     charged to the plan and participants, beneficiaries, and 
     enrollees, that is available from any pharmacy included in 
     the network of such plan or coverage; and
       ``(dd) the net acquisition cost per dosage unit, per 30-day 
     supply, and per 90-day supply, if such drug is subject to a 
     maximum price discount;
       ``(B) in the case of a plan or coverage not described in 
     subparagraph (A)--
       ``(i) the total net spending by the plan or coverage for 
     all drugs covered by such plan or coverage during such 
     reporting period;
       ``(ii) the total amount received, or expected to be 
     received, by the plan or coverage from any entity in drug 
     manufacturer rebates, fees, alternative discounts, and all 
     other remuneration received from an entity or any third party 
     (including group purchasing organizations) other than the 
     plan sponsor for all such drugs; and
       ``(iii) to the extent feasible, information on the total 
     amount of remuneration, including copayment assistance 
     dollars paid, copayment cards applied, or other discounts 
     provided by each drug manufacturer (or entity administering 
     copay assistance on behalf of such drug manufacturer) to the 
     participants, beneficiaries, and enrollees enrolled in such 
     plan or coverage for such drugs;
       ``(C) 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 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 
     an entity providing pharmacy benefits management services, 
     including the identity of the recipient of such amounts;
       ``(D) an explanation of any benefit design parameters that 
     encourage or require participants, beneficiaries, and 
     enrollees in such 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 directly or indirectly 
     funded by such entity; and
       ``(E) total gross spending on all drugs during the 
     reporting period.
       ``(3) Privacy requirements.--
       ``(A) In general.--Health insurance issuers offering group 
     health insurance coverage and entities providing pharmacy 
     benefits management services on behalf of a group health

[[Page H6775]]

     plan shall provide information under paragraph (1) in a 
     manner consistent with the privacy, security, and breach 
     notification regulations promulgated under section 13402(a) 
     of the Health Information Technology for Clinical Health Act 
     and consistent with the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act) and shall 
     restrict the use and disclosure of such information according 
     to such privacy, security, and breach notification 
     regulations and such HIPAA privacy regulations.
       ``(B) Additional requirements.--
       ``(i) In general.--An entity providing pharmacy benefits 
     management services on behalf of a group health plan or 
     health insurance issuer offering group health insurance 
     coverage that submits a report under paragraph (1) shall 
     ensure that such report contains only summary health 
     information, as defined in section 164.504(a) of title 45, 
     Code of Federal Regulations (or successor regulations).
       ``(ii) Restrictions.--A group health plan shall comply with 
     section 164.504(f) of title 45, Code of Federal Regulations 
     (or a successor regulation) and a plan sponsor shall act in 
     accordance with the terms of the agreement described in such 
     section.
       ``(C) Rule of construction.--Nothing in this section shall 
     be construed to modify the requirements for the creation, 
     receipt, maintenance, or transmission of protected health 
     information under the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act).
       ``(4) Disclosure and redisclosure.--
       ``(A) Limitation to business associates.--A group health 
     plan receiving a report under paragraph (1) may disclose such 
     information only to the entity from which the report was 
     received or to that entity's business associates as defined 
     in section 160.103 of title 45, Code of Federal Regulations 
     (or successor regulations) or as permitted by the HIPAA 
     Privacy Rule (45 CFR parts 160 and 164, subparts A and E).
       ``(B) Clarification regarding public disclosure of 
     information.--Nothing in this section shall prevent a group 
     health plan or health insurance issuer offering group health 
     insurance coverage, or an entity providing pharmacy benefits 
     management services on behalf of such a plan or coverage, 
     from placing reasonable restrictions on the public disclosure 
     of the information contained in a report described in 
     paragraph (1), except that such plan, 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, or the Comptroller General of the 
     United States.
       ``(C) Limited form of report.--The Secretary shall define 
     through rulemaking a limited form of the report under 
     paragraph (1) required with respect to group health plans 
     where the plan sponsors of such plans are drug manufacturers, 
     drug wholesalers, or other direct participants in the drug 
     supply chain, in order to prevent anti-competitive behavior.
       ``(5) Report to gao.--A group health plan or health 
     insurance issuer offering group health insurance coverage, or 
     an entity providing pharmacy benefits management services on 
     behalf of such plan or coverage, shall submit to the 
     Comptroller General of the United States each of the first 4 
     reports submitted to a group health plan under paragraph (1) 
     and other such reports as requested, in accordance with the 
     privacy requirements under paragraph (3), the disclosure and 
     redisclosure standards under paragraph (4), the standards 
     specified pursuant to paragraph (6), and such other 
     information that the Comptroller General determines necessary 
     to carry out the study under section 106(d) of the Lower 
     Costs, More Transparency Act.
       ``(6) Standard format.--Not later than 1 year after the 
     date of enactment of this section, the Secretary shall 
     specify through rulemaking standards for group health plans, 
     health insurance issuers offering group health insurance 
     coverage, and entities providing pharmacy benefits management 
     services on behalf of such plans or coverage, required to 
     submit reports under paragraph (1) to submit such reports in 
     a standard format.
       ``(c) Rule of Construction.--Nothing in this section shall 
     be construed to permit a group health plan, health insurance 
     issuer, or entity providing pharmacy benefits management 
     services on behalf of such plan or coverage, to restrict 
     disclosure to, or otherwise limit the access of, the 
     Secretary of Labor to a report described in subsection (b)(1) 
     or information related to compliance with subsection (a) or 
     (b) by entities subject to such subsection.
       ``(d) Definitions.--In this section:
       ``(1) Specified large employer.--The term `specified 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.''.
       (B) in section 502 (29 U.S.C. 1132)--
       (i) in subsection (b)(3), by striking ``under subsection 
     (c)(9))'' and inserting ``under paragraphs (9) and (13) of 
     subsection (c))''; and
       (ii) 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 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.''.
       (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:

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

       ``(a) In General.--For plan years beginning on or after the 
     date that is 2 years after the date of enactment of this 
     section, a group health plan, or an entity or subsidiary 
     providing pharmacy benefits management services on behalf of 
     such a plan, shall not enter into a contract with a drug 
     manufacturer, distributor, wholesaler, subcontractor, rebate 
     aggregator, or any other third party that limits (or delays 
     beyond the applicable reporting period described in 
     subsection (b)(1)) the disclosure of information to group 
     health plans in such a manner that prevents such plan or 
     entity from making the reports described in subsection (b).
       ``(b) Reports.--
       ``(1) In general.--With respect to plan years beginning on 
     or after the date that is 2 years after the date of enactment 
     of this section, not less frequently than every 6 months (or 
     at the request of a group health plan, not less frequently 
     than quarterly, but under the same conditions, terms, and 
     cost of the semiannual report under this subsection), a group 
     health plan, or an entity providing pharmacy benefits 
     management services on behalf of such a plan, shall submit to 
     the group health plan a report in accordance with this 
     section. Each such report shall be made available to such 
     group health plan in a machine-readable format and shall 
     include the information described in paragraph (2).
       ``(2) Information described.--For purposes of paragraph 
     (1), the information described in this paragraph is, with 
     respect to drugs covered by a group health plan during each 
     reporting period--
       ``(A) in the case of such a plan offered by a specified 
     large employer--
       ``(i) a list of drugs for which a claim was filed and, with 
     respect to each such drug on such list--

       ``(I) the brand name, chemical entity, and National Drug 
     Code;
       ``(II) the type of dispensing channel used to furnish such 
     drug, including retail, mail order, or specialty pharmacy;
       ``(III) with respect to each drug dispensed under each type 
     of dispensing channel (including retail, mail order, or 
     specialty pharmacy)--

       ``(aa) whether such drug is a brand name drug or a generic 
     drug, and--
       ``(AA) in the case of a brand name drug, the wholesale 
     acquisition cost, listed as cost per days supply and cost per 
     dosage unit, on the date such drug was dispensed; and
       ``(BB) in the case of a generic drug, the average wholesale 
     price, listed as cost per days supply and cost per dosage 
     unit, on the date such drug was dispensed; and
       ``(bb) the total number of--
       ``(AA) prescription claims (including original 
     prescriptions and refills);
       ``(BB) participants, beneficiaries, and enrollees for whom 
     a claim for such drug was filed;
       ``(CC) dosage units per fill of such drug; and
       ``(DD) days supply of such drug per fill;

       ``(IV) the net price per course of treatment or single 
     fill, such as a 30-day supply or 90-day supply to the plan 
     after manufacturer rebates, fees, and other remuneration or 
     adjustments;
       ``(V) the total amount of out-of-pocket spending by 
     participants, beneficiaries, and enrollees on such drug, 
     including spending through copayments, coinsurance, and 
     deductibles;
       ``(VI) the total net spending by the plan during the 
     reporting period;
       ``(VII) the total amount received, or expected to be 
     received, by the plan from any

[[Page H6776]]

     entity in drug manufacturer rebates, fees, alternative 
     discounts, and all other remuneration received from an entity 
     or any third party (including group purchasing organizations) 
     other than the plan sponsor;
       ``(VIII) the total amount received, or expected to be 
     received by the plan, from drug manufacturers in rebates, 
     fees, alternative discounts, or other remuneration--

       ``(aa) that has been paid, or is to be paid, by drug 
     manufacturers for claims incurred during the reporting 
     period; and
       ``(bb) that is related to utilization rebates for such 
     drug; and

       ``(IX) to the extent feasible, information on the total 
     amount of remuneration, including copayment assistance 
     dollars paid, copayment cards applied, or other discounts 
     provided by each drug manufacturer (or entity administering 
     copay assistance on behalf of such drug manufacturer) to the 
     participants, beneficiaries, and enrollees enrolled in such 
     plan for such drug;

       ``(ii) for each category or class of drugs for which a 
     claim was filed, a breakdown of the total gross spending on 
     drugs in such category or class before rebates, price 
     concessions, alternative discounts, or other remuneration 
     from drug manufacturers, and the net spending after such 
     rebates, price concessions, alternative discounts, or other 
     remuneration from drug manufacturers, including--

       ``(I) the number of participants, beneficiaries, and 
     enrollees who filled a prescription for a drug in such 
     category or class, including the National Drug Code for each 
     such drug;
       ``(II) if applicable, a description of the formulary tiers 
     and utilization mechanisms (such as prior authorization or 
     step therapy) employed for drugs in that category or class;
       ``(III) the total out-of-pocket spending under the plan by 
     participants, beneficiaries, and enrollees, including 
     spending through copayments, coinsurance, and deductibles; 
     and

       ``(iii) in the case of a drug for which gross spending by 
     such plan or entity exceeded $10,000 during the reporting 
     period--

       ``(I) a list of all other drugs in the same therapeutic 
     category or class; and
       ``(II) the rationale for the formulary placement of such 
     drug in that therapeutic category or class, if applicable; 
     and

       ``(iv) in the case such plan (or an entity providing 
     pharmacy benefits management services on behalf of such plan) 
     that has an affiliated pharmacy or pharmacy under common 
     ownership--

       ``(I) the percentage of total prescriptions dispensed by 
     such pharmacies to individuals enrolled in such plan;
       ``(II) a list of all drugs dispensed by such pharmacies to 
     individuals enrolled in such plan, and, with respect to each 
     drug dispensed--

       ``(aa) the amount charged, per dosage unit, per 30-day 
     supply, or per 90-day supply (as applicable) to the plan, and 
     to participants, beneficiaries, and enrollees enrolled in 
     such plan;
       ``(bb) the median amount charged to such plan, and the 
     interquartile range of the costs, per dosage unit, per 30-day 
     supply, and per 90-day supply, including amounts paid by the 
     participants, beneficiaries, and enrollees, 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;
       ``(cc) the lowest cost per dosage unit, per 30-day supply 
     and per 90-day supply, for each such drug, including amounts 
     charged to the plan and participants, beneficiaries, and 
     enrollees, that is available from any pharmacy included in 
     the network of such plan; and
       ``(dd) the net acquisition cost per dosage unit, per 30-day 
     supply, and per 90-day supply, if such drug is subject to a 
     maximum price discount;
       ``(B) in the case of a plan not described in subparagraph 
     (A)--
       ``(i) the total net spending by the plan for all drugs 
     covered by such plan during such reporting period;
       ``(ii) the total amount received, or expected to be 
     received, by the plan from any entity in drug manufacturer 
     rebates, fees, alternative discounts, and all other 
     remuneration received from an entity or any third party 
     (including group purchasing organizations) other than the 
     plan sponsor for all such drugs; and
       ``(iii) to the extent feasible, information on the total 
     amount of remuneration, including copayment assistance 
     dollars paid, copayment cards applied, or other discounts 
     provided by each drug manufacturer (or entity administering 
     copay assistance on behalf of such drug manufacturer) to the 
     participants, beneficiaries, and enrollees enrolled in such 
     plan for such drugs;
       ``(C) 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) to brokers, consultants, advisors, or any other 
     individual or firm, for the referral of the group health 
     plan's business to an entity providing pharmacy benefits 
     management services, including the identity of the recipient 
     of such amounts;
       ``(D) an explanation of any benefit design parameters that 
     encourage or require participants, beneficiaries, and 
     enrollees in such 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 directly or indirectly funded by such entity; and
       ``(E) total gross spending on all drugs during the 
     reporting period.
       ``(3) Privacy requirements.--
       ``(A) In general.--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 13402(a) 
     of the Health Information Technology for Clinical Health Act 
     and consistent with the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act) and shall 
     restrict the use and disclosure of such information according 
     to such privacy, security, and breach notification 
     regulations and such HIPAA privacy regulations.
       ``(B) Additional requirements.--
       ``(i) In general.--An entity providing pharmacy benefits 
     management services on behalf of a group health plan that 
     submits a report under paragraph (1) shall ensure that such 
     report contains only summary health information, as defined 
     in section 164.504(a) of title 45, Code of Federal 
     Regulations (or successor regulations).
       ``(ii) Restrictions.--A group health plan shall comply with 
     section 164.504(f) of title 45, Code of Federal Regulations 
     (or a successor regulation) and a plan sponsor shall act in 
     accordance with the terms of the agreement described in such 
     section.
       ``(C) Rule of construction.--Nothing in this section shall 
     be construed to modify the requirements for the creation, 
     receipt, maintenance, or transmission of protected health 
     information under the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act).
       ``(4) Disclosure and redisclosure.--
       ``(A) Limitation to business associates.--A group health 
     plan receiving a report under paragraph (1) may disclose such 
     information only to the entity from which the report was 
     received or to that entity's business associates as defined 
     in section 160.103 of title 45, Code of Federal Regulations 
     (or successor regulations) or as permitted by the HIPAA 
     Privacy Rule (45 CFR parts 160 and 164, subparts A and E).
       ``(B) Clarification regarding public disclosure of 
     information.--Nothing in this section shall prevent a group 
     health plan or health insurance issuer offering group health 
     insurance coverage, or an entity providing pharmacy benefits 
     management services on behalf of such a plan or coverage, 
     from placing reasonable restrictions on the public disclosure 
     of the information contained in a report described in 
     paragraph (1), except that such plan, 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, or the Comptroller General of the 
     United States.
       ``(C) Limited form of report.--The Secretary shall define 
     through rulemaking a limited form of the report under 
     paragraph (1) required with respect to group health plans 
     where the plan sponsors of such plans are drug manufacturers, 
     drug wholesalers, or other direct participants in the drug 
     supply chain, in order to prevent anti-competitive behavior.
       ``(5) Report to gao.--A group health plan, or an entity 
     providing pharmacy benefits management services on behalf of 
     such plan, shall submit to the Comptroller General of the 
     United States each of the first 4 reports submitted to a 
     group health plan under paragraph (1) and other such reports 
     as requested, in accordance with the privacy requirements 
     under paragraph (3), the disclosure and redisclosure 
     standards under paragraph (4), the standards specified 
     pursuant to paragraph (6), and such other information that 
     the Comptroller General determines necessary to carry out the 
     study under section 106(d) of the Lower Costs, More 
     Transparency Act.
       ``(6) Standard format.--Not later than 1 year after the 
     date of enactment of this section, the Secretary shall 
     specify through rulemaking standards for group health plans, 
     and entities providing pharmacy benefits management services 
     on behalf of such plans, required to submit reports under 
     paragraph (1) to submit such reports in a standard format.
       ``(c) Rule of Construction.--Nothing in this section shall 
     be construed to permit a group health plan or entity 
     providing pharmacy benefits management services on behalf of 
     such plan, to restrict disclosure to, or otherwise limit the 
     access of, the Secretary of Health and Human Services to a 
     report described in subsection (b)(1) or information related 
     to compliance with subsections (a) or (b) by entities subject 
     to such subsection.
       ``(d) Definitions.--In this section:
       ``(1) Specified large employer.--The term `specified 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.''.

[[Page H6777]]

       (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.''.
       (d) GAO Reports.--
       (1) Report on pharmacy network design.--
       (A) In general.--Not later than 3 years after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to Congress a report on--
       (i) pharmacy networks that have contracted with group 
     health plans, health insurance issuers offering group health 
     insurance coverage, or entities providing pharmacy benefits 
     management services on behalf of such plans or issuers, 
     including networks with pharmacies that are under common 
     ownership (in whole or part) with such plans, issuers, or 
     entities (including entities that provide pharmacy benefits 
     administrative services on behalf of such plans or issuers);
       (ii) pharmacy network design parameters that encourage 
     individuals enrolled in such plans or coverage to fill 
     prescriptions at mail order, specialty, or retail pharmacies 
     that are wholly or partially owned by a plan, issuer, or 
     entity;
       (iii) whether such plans and issuers have options to elect 
     different network pricing arrangements in the marketplace 
     with entities that provide pharmacy benefits management 
     services and the prevalence of electing such different 
     network pricing arrangements;
       (iv) with respect to pharmacy networks that include 
     pharmacies under common ownership described in clause (i)--

       (I) whether such networks are designed to encourage 
     individuals enrolled in a group health plan or health 
     insurance coverage to use such pharmacies over other network 
     pharmacies for specific services or drugs, and if so, the 
     reasons the networks give for encouraging use of such 
     pharmacies; and
       (II) whether such pharmacies are used by enrollees 
     disproportionately more in the aggregate or for specific 
     services or drugs compared to other network pharmacies;

       (v) the degree to which mail order, specialty, or retail 
     pharmacies that dispense prescription drugs to an enrollee in 
     a plan or coverage that are under common ownership (in whole 
     or part) with plans, issuers, or entities providing pharmacy 
     benefits management services or pharmacy benefits 
     administrative services on behalf of such plan or coverage 
     receive reimbursement that is greater than the median price 
     charged to the plan or issuer when the same drug is dispensed 
     to enrollees in the plan or coverage by other pharmacies 
     included in the pharmacy network of that plan, issuer, or 
     entity that are not wholly or partially owned by the plan or 
     issuer, or entity providing pharmacy benefits management 
     services on behalf of such plan or issuer.
       (B) Requirement.--The Comptroller General of the United 
     States shall ensure that the report under subparagraph (A) 
     does not contain information that would identify a specific 
     group health plan or health insurance issuer (or an entity 
     providing pharmacy benefits management services on behalf of 
     such plan or issuer), or otherwise contain commercial or 
     financial information that is privileged or confidential.
       (C) Definitions.--In this paragraph, the terms ``group 
     health plan'', ``health insurance coverage'', and ``health 
     insurance issuer'' have the meanings given such terms in 
     section 2791 of the Public Health Service Act (42 U.S.C. 
     300gg-91).
       (2) Report on copay assistance programs.--Not later than 18 
     months after the date of the enactment of this Act, the 
     Comptroller General of the United States shall submit to 
     Congress a report on what is known about the role of copay 
     assistance programs and the impact of such programs on 
     commercial health insurance, stop loss, and drug prices. Such 
     report shall include to the extent feasible--
       (A) a description of copay assistance programs, including--
       (i) the types of programs available and the methods of 
     providing copay assistance through such programs, including 
     cash discounts, copay cards, or drugs provided to an 
     individual at no cost;
       (ii) how such programs are funded;
       (iii) the types of entities that own, operate, or otherwise 
     conduct such programs, the types of information such entities 
     collect, and the direct and indirect contractual 
     relationships between the entities in the drug supply chain 
     that interact with such programs, such as a drug 
     manufacturer, pharmacy, wholesaler, switch, rebate 
     aggregator, pharmacy benefit manager, and other entities in 
     the drug supply chain;
       (iv) the effect of such programs on patient out-of-pocket 
     spending, including for stop-loss insurance, and drug 
     utilization, including drug adherence; and
       (v) patient eligibility criteria for such programs; and
       (B) an analysis of--
       (i) the sources of funding for such programs; and
       (ii) the effects of such programs on Federal health care 
     programs and the individuals enrolled in such Federal health 
     care programs.

     SEC. 107. REPORTS ON HEALTH CARE TRANSPARENCY TOOLS AND DATA.

       (a) Initial Report.--Not later than December 31, 2024, the 
     Comptroller General of the United States shall submit to the 
     Committees (as defined in subsection (d)) an initial report 
     that--
       (1) identifies and describes health care transparency tools 
     and Federal health care reporting requirements (as described 
     in subsection (d)) that are in effect as of the date of the 
     submission of such initial report, including the frequency of 
     reports with respect to each such requirement and whether any 
     such requirements are duplicative;
       (2) reviews how such reporting requirements are enforced;
       (3) analyzes whether the public availability of health care 
     transparency tools, and the publication of data pursuant to 
     such reporting requirements, has--
       (A) been utilized and valued by consumers, including 
     reasons for such utilization (or lack thereof); and
       (B) assisted health insurance plan sponsors and fiduciaries 
     improve benefits, lower health care costs for plan 
     participants, and meet fiduciary requirements;
       (4) includes recommendations to the Committees, the 
     Secretary of Health and Human Services, the Secretary of 
     Labor, and the Secretary of the Treasury to--
       (A) improve the efficiency, accuracy, and usability of 
     health care transparency tools;
       (B) streamline Federal health care reporting requirements 
     to eliminate duplicative requirements and reduce the burden 
     on entities required to submit reports pursuant to such 
     provisions;
       (C) improve the accuracy and efficiency of such reports 
     while maintaining the integrity and usability of the data 
     provided by such reports;
       (D) address any gaps in data provided by such reports; and
       (E) ensure that the data and information reported is 
     comparable and usable to consumers, including patients, plan 
     sponsors, and policy makers.
       (b) Final Report.--Not later than December 31, 2028, the 
     Comptroller General of the United States shall submit to the 
     Committees a report that includes--
       (1) the information provided in the initial report, along 
     with any updates to such information; and
       (2) any new information with respect to health care 
     transparency tools that have been released following the 
     submission of such initial report, or new reporting 
     requirements in effect as of the date of the submission of 
     the final report.
       (c) Report on Expanding Price Transparency Requirements.--
     Not later than December 31, 2025, the Comptroller General of 
     the United States, in consultation with the Secretary of 
     Health and Human Services, health care provider groups, and 
     patient advocacy groups, shall submit to the Committees a 
     report that includes recommendations to expand price 
     transparency reporting requirements to additional care 
     settings, with an emphasis on settings where shoppable 
     services (as defined in subsection (d)) are furnished.
       (d) Definitions.--In this section:
       (1) Committees.--The term ``Committees'' means the 
     Committee on Ways and Means, the Committee on Energy and 
     Commerce, and the Committee on Education and the Workforce of 
     the House of Representatives, and the Committee on Finance 
     and the Committee on Health, Education, Labor, and Pensions 
     of the Senate.
       (2) Federal health care reporting requirements.--The term 
     ``Federal health care reporting requirements'' includes 
     regulatory and statutory requirements with respect to the 
     reporting and publication of health care price, cost access, 
     and quality data, including requirements established by the 
     Consolidated Appropriations Act of 2021 (Public Law 116-260), 
     this Act, and other reporting and publication requirements 
     with respect to transparency in health care as identified by 
     the Comptroller General of the United States.
       (3) Shoppable service.--The term ``shoppable service'' 
     means a service that can be scheduled by a health care 
     consumer in advance and includes all ancillary items and 
     services customarily furnished as part of such service.

     SEC. 108. REPORT ON INTEGRATION IN MEDICARE.

       (a) Required MA and PDP Reporting.--
       (1) MA plans.--Section 1857(e) of the Social Security Act 
     (42 U.S.C. 1395w-27(e)) is amended by adding at the end the 
     following new paragraph:
       ``(6) Required disclosure of certain information relating 
     to health care provider ownership.--
       ``(A) In general.--For plan year 2025 and for every third 
     plan year thereafter, each applicable MA organization 
     offering an MA plan under this part during such plan year 
     shall submit to the Secretary, at a time and in a manner 
     specified by the Secretary--
       ``(i) the taxpayer identification number for each health 
     care provider that was a specified health care provider with 
     respect to such organization during such year;
       ``(ii) the total amount of incentive-based payments made 
     to, and the total amount of shared losses recoupments 
     collected from, such specified health care providers during 
     such plan year; and
       ``(iii) the total amount of incentive-based payments made 
     to, and the total amount of shared losses recoupments 
     collected from, providers of services and suppliers not 
     described in clause (ii) during such plan year.
       ``(B) Definitions.--For purposes of this paragraph:
       ``(i) Applicable ma organization.--The term `applicable MA 
     organization' means,

[[Page H6778]]

     with respect to a plan year, an MA organization with at least 
     25,000 individuals enrolled under Medicare Advantage plans 
     offered by such organization during such plan year.
       ``(ii) Specified health care provider.--The term `specified 
     health care provider' means, with respect to an applicable MA 
     organization and a plan year, a provider of services or 
     supplier with respect to which such organization (or any 
     person with an ownership or control interest (as defined in 
     section 1124(a)(3)) in such organization) is a person with an 
     ownership or control interest (as so defined).''.
       (2) Prescription drug plans.--Section 1860D-12(b) of the 
     Social Security Act (42 U.S.C. 1395w-112(b)) is amended by 
     adding at the end the following new paragraph:
       ``(9) Provision of information relating to pharmacy 
     ownership.--
       ``(A) In general.--For plan year 2025 and for every third 
     plan year thereafter, each PDP sponsor offering a 
     prescription drug plan under this part during such plan year 
     shall submit to the Secretary, at a time and in a manner 
     specified by the Secretary, the taxpayer identification 
     number and National Provider Identifier for each pharmacy 
     that was a specified pharmacy with respect to such sponsor 
     during such year.
       ``(B) Definition.--For purposes of this paragraph, the term 
     `specified pharmacy' means, with respect to an PDP sponsor 
     offering a prescription drug plan and a plan year, a pharmacy 
     with respect to which--
       ``(i) such sponsor (or any person with an ownership or 
     control interest (as defined in section 1124(a)(3)) in such 
     sponsor) is a person with an ownership or control interest 
     (as so defined); or
       ``(ii) a pharmacy benefit manager offering services under 
     such plan (or any person with an ownership or control 
     interest (as so defined) in such sponsor) is a person with an 
     ownership or control interest (as so defined).''.
       (b) MedPAC Reports.--Part E of title XVIII of the Social 
     Security Act (42 U.S.C. 1395x et seq.), as amended by section 
     101, is further amended by adding at the end the following 
     new section:

     ``SEC. 1899D. REPORTS ON VERTICAL INTEGRATION UNDER MEDICARE.

       ``(a) In General.--Not later than June 15, 2029, and every 
     3 years thereafter, the Medicare Payment Advisory Commission 
     shall submit to Congress a report on the state of vertical 
     integration in the health care sector during the applicable 
     year with respect to entities participating in the Medicare 
     program, including health care providers, pharmacies, 
     prescription drug plan sponsors, Medicare Advantage 
     organizations, and pharmacy benefit managers. Such report 
     shall include--
       ``(1) with respect to Medicare Advantage organizations, the 
     evaluation described in subsection (b);
       ``(2) with respect to prescription drug plans, pharmacy 
     benefit managers, and pharmacies, the comparisons and 
     evaluations described in subsection (c);
       ``(3) with respect to Medicare Advantage plans under which 
     benefits are available for physician-administered drugs, the 
     information described in subsection (d);
       ``(4) the identifications described in subsection (e); and
       ``(5) an analysis of the impact of such integration on 
     health care access, price, quality, and outcomes.
       ``(b) Medicare Advantage Organizations.--For purposes of 
     subsection (a)(1), the evaluation described in this 
     subsection is, with respect to Medicare Advantage 
     organizations and an applicable year, an evaluation, taking 
     into account patient acuity and the types of areas serviced 
     by such organization, of--
       ``(1) the average number of qualifying diagnoses made 
     during such year with respect to enrollees of a Medicare 
     Advantage plan offered by such organization who, during such 
     year, received a health risk assessment from a specified 
     health care provider;
       ``(2) the average risk score for such enrollees who 
     received such an assessment during such year;
       ``(3) any relationship between such risk scores for such 
     enrollees receiving such an assessment from such a provider 
     during such year and incentive payments made to such 
     providers;
       ``(4) the average risk score for enrollees of such plan who 
     received any item or service from a specified health care 
     provider during such year;
       ``(5) any relationship between the risk scores of enrollees 
     under such plan and whether the enrollees have received any 
     item or service from a specified provider; and
       ``(6) any relationship between the risk scores of enrollees 
     under such plan that have received any item or service from a 
     specified provider and incentive payments made under the plan 
     to specified providers.
       ``(c) Prescription Drug Plans.--For purposes of subsection 
     (a)(2), the comparisons and evaluations described in this 
     subsection are, with respect to prescription drug plans and 
     an applicable year, the following:
       ``(1) For each covered part D drug for which benefits are 
     available under such a plan, a comparison of the average 
     negotiated rate in effect with specified pharmacies with such 
     rates in effect for in-network pharmacies that are not 
     specified pharmacies.
       ``(2) Comparisons of the following:
       ``(A) The total amount paid by pharmacy benefit managers to 
     specified pharmacies for covered part D drugs and the total 
     amount so paid to pharmacies that are not specified 
     pharmacies for such drugs.
       ``(B) The total amount paid by such sponsors to specified 
     pharmacy benefit managers as reimbursement for covered part D 
     drugs and the total amount so paid to pharmacy benefit 
     managers that are not specified pharmacy benefit managers as 
     such reimbursement.
       ``(C) Fees paid under by plan to specified pharmacy benefit 
     managers compared to such fees paid to pharmacy benefit 
     managers that are not specified pharmacy benefit managers.
       ``(3) An evaluation of the total amount of direct and 
     indirect remuneration for covered part D drugs passed through 
     to prescription drug plan sponsors and the total amount 
     retained by pharmacy benefit managers (including entities 
     under contract with such a manager).
       ``(4) To the extent that the available data permits, an 
     evaluation of fees charged by rebate aggregators that are 
     affiliated with plan sponsors.
       ``(d) Physician-administered Drugs.--For purposes of 
     subsection (a)(3), the information described in this 
     subsection is, with respect to physician-administered drugs 
     for which benefits are available under a Medicare Advantage 
     plan during an applicable year, the following:
       ``(1) With respect to each such plan, an identification of 
     each drug for which benefits were available under such plan 
     only when administered by a health care provider that 
     acquired such drug from an affiliated pharmacy.
       ``(2) An evaluation of the difference between the total 
     number of drugs administered by a health care provider that 
     were acquired from affiliated pharmacies compared to the 
     number of such drugs so administered that were acquired from 
     pharmacies other than affiliated pharmacies, and an 
     evaluation of the difference in payments for such drugs so 
     administered when acquired from a specified pharmacy and when 
     acquired from a pharmacy that is not a specified pharmacy.
       ``(3) An evaluation of the dollar value of all such drugs 
     that were not so administered because of a delay attributable 
     to an affiliated pharmacy compared to the dollar value of all 
     such drugs that were not so administered because of a delay 
     attributable to pharmacy that is not an affiliated pharmacy.
       ``(4) The number of enrollees administered such a drug that 
     was acquired from an affiliated pharmacy.
       ``(5) The number of enrollees furnished such a drug that 
     was acquired from a pharmacy that is not an affiliated 
     pharmacy.
       ``(e) Identifications.--For purposes of subsection (a)(4), 
     the identifications described in this subsection are, with 
     respect to an applicable year, identifications of each health 
     care entity participating under the Medicare program with 
     respect to which another health care entity so participating 
     is a person with an ownership or control interest (as defined 
     in section 1124(a)(3)).
       ``(f) Definitions.--In this section:
       ``(1) Affiliated pharmacy.--The term `affiliated pharmacy' 
     means, with respect to a Medicare Advantage plan offered by a 
     Medicare Advantage organization, a pharmacy with respect to 
     which such organization (or any person with an ownership or 
     control interest (as defined in section 1124(a)(3)) in such 
     organization) is a person with an ownership or control 
     interest (as so defined).
       ``(2) Applicable year.--The term `applicable year' means, 
     with respect to a report submitted under subsection (a), the 
     first calendar year beginning at least 4 years prior to the 
     date of the submission of such report.
       ``(3) Covered part d drug.--The term `covered part D drug' 
     has the meaning given such term in section 1860D-2(e).
       ``(4) Direct and indirect remuneration.--The term `direct 
     and indirect remuneration' has the meaning given such term in 
     section 423.308 of title 42, Code of Federal Regulations (or 
     any successor regulation).
       ``(5) Qualifying diagnosis.--The term `qualifying 
     diagnosis' means, with respect to an enrollee of a Medicare 
     Advantage plan, a diagnosis that is taken into account in 
     calculating a risk score for such enrollee under the risk 
     adjustment methodology established by the Secretary pursuant 
     to section 1853(a)(3).
       ``(6) Risk score.--The term `risk score' means, with 
     respect to an enrollee of a Medicare Advantage plan, the 
     score calculated for such individual using the methodology 
     described in paragraph (5).
       ``(7) Physician-administered drug.--The term `physician-
     administered drug' means a drug furnished to an individual 
     that, had such individual been enrolled under part B and not 
     enrolled under part C, would have been payable under section 
     1842(o).
       ``(8) Specified health care provider.--The term `specified 
     health care provider' means, with respect to a Medicare 
     Advantage plan offered by a Medicare Advantage organization, 
     a health care provider with respect to which such 
     organization (or any person with an ownership or control 
     interest (as defined in section 1124(a)(3)) in such 
     organization) is a person with an ownership or control 
     interest (as so defined).
       ``(9) Specified pharmacy.--The term `specified pharmacy' 
     means, with respect to a prescription drug plan offered by a 
     prescription drug plan sponsor, a pharmacy with respect to 
     which--
       ``(A) such sponsor (or any person with an ownership or 
     control interest (as defined in

[[Page H6779]]

     section 1124(a)(3)) in such sponsor) is a person with an 
     ownership or control interest (as so defined); or
       ``(B) a pharmacy benefit manager offering services under 
     such plan (or any person with an ownership or control 
     interest (as so defined) in such sponsor) is a person with an 
     ownership or control interest (as so defined).
       ``(10) Specified pharmacy benefit manager.--The term 
     `specified pharmacy benefit manager' means, with respect to a 
     prescription drug plan offered by a prescription drug plan 
     sponsor, a pharmacy benefit manager with respect to which 
     such sponsor (or any person with an ownership or control 
     interest (as defined in section 1124(a)(3)) in such sponsor) 
     is a person with an ownership or control interest (as so 
     defined).''.

     SEC. 109. ADVISORY COMMITTEE.

       (a) In General.--Not later than January 1, 2025, the 
     Secretary of Labor, the Secretary of Health and Human 
     Services, and the Secretary of the Treasury shall jointly 
     convene an advisory committee (in this section referred to as 
     the ``committee'') consisting of 9 members to advise the 
     Secretaries on how to improve the usefulness, accessibility, 
     and usability of information made available in accordance the 
     amendments made by sections 105 and 106, 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--
       (1) such information is accurate, accessible, and is 
     delivered in a form and manner consistent with the 
     requirements of such section;
       (2) the form and manner in which such information is 
     delivered is routinely updated in accordance with widely-used 
     practices in order to ensure accessibility; and
       (3) such information is available for audit (including by 
     making recommendations relating to how Federal and State 
     actors may conduct such audits).
       (b) Membership.--The Secretaries shall jointly 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 shall terminate on January 
     1, 2028.
       (d) Nonapplicaiton of FACA.--The Federal Advisory Committee 
     Act (5 U.S.C. App.) shall not apply to the committee.

     SEC. 110. REPORT ON IMPACT OF MEDICARE REGULATIONS ON 
                   PROVIDER AND PAYER CONSOLIDATION.

       (a) Annual Report on the Impact of Certain Medicare 
     Regulations on Provider and Payer Consolidation; Public 
     Comment on Provider and Payer Consolidation for Certain 
     Proposed Rules.--
       (1) Annual report.--Not later than December 30, 2026, and 
     annually thereafter, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall submit to Congress a report on the impact in the 
     aggregate on provider and payer consolidation with respect to 
     regulations for parts A, B, C, and D of title XVIII of the 
     Social Security Act (42 U.S.C. 1395 et seq.) implemented in 
     the calendar year immediately prior to such report. Such 
     report shall include regulations that--
       (A) implement a change to an applicable payment system, a 
     rate schedule, or another payment system under part A, B, C, 
     or D of such title; or
       (B) result in a significant rule effecting provider or 
     payer consolidation.
       (2) Public comment on impact to provider and payer 
     consolidation.--Beginning for 2025, as part of any notice and 
     comment rulemaking process that will result in a significant 
     rule effecting provider or payer consolidation with respect 
     to a proposed rule for parts A, B, C, and D of title XVIII of 
     the Social Security Act (42 U.S.C. 1395j et seq.), the 
     Secretary shall seek public comment on the projected impact 
     of such proposed rule on provider and payer consolidation in 
     the aggregate.
       (3) Definitions.--In this section:
       (A) Provider and payer consolidation.--The term ``provider 
     and payer consolidation'' includes the vertical or horizontal 
     integration among providers of services (as defined in 
     subsection (u) of section 1861 of the Social Security Act (42 
     U.S.C. 1395x)), suppliers (as defined in subsection (d) of 
     such section), accountable care organizations under section 
     1899 of the Social Security Act (42 U.S.C. 1395jjj), Medicare 
     Advantage organizations, PDP sponsors, pharmacy benefit 
     managers, pharmacies, and integrated delivery systems.
       (B) Applicable payment system.--The term ``applicable 
     payment system'' includes--
       (i) with respect to outpatient hospital services, the 
     prospective payment system for covered OPD services 
     established under section 1833(t) of such Act (42 U.S.C. 
     1395(l)); and
       (ii) with respect to physicians' services, the physician 
     fee schedules established under section 1848 of such Act (42 
     U.S.C. 1395w-4).
       (b) Consideration of Effects on Provider and Payer 
     Consolidation With Respect to CMI Models.--
       (1) In general.--Section 1115A(b)(4)(A) of the Social 
     Security Act (42 U.S.C. 1315a(b)(4)(A)) is amended--
       (A) in clause (i), by striking at the end ``and'';
       (B) in clause (ii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iii) the extent to which, and how, the model has 
     effected and could effect provider and payer consolidation, 
     which includes the vertical or horizontal integration among 
     providers of services (as defined in subsection (u) of 
     section 1861), suppliers (as defined in subsection (d) of 
     such section), and accountable care organizations under 
     section 1899.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply with respect to models tested on or after January 
     1, 2025.

     SEC. 111. IMPLEMENTATION FUNDING.

       (a) In General.--For the purposes described in subsection 
     (b), there are appropriated, in addition to amounts otherwise 
     available, out of amounts in the Treasury not otherwise 
     appropriated, to the Secretary of Health and Human Services 
     and the Secretary of the Treasury, $65,000,000 for fiscal 
     year 2024, to remain available through fiscal year 2029.
       (b) Permitted Purposes.--The purposes described in this 
     subsection are the following purposes, insofar as such 
     purposes are to carry out the provisions of, including the 
     amendments made by, this title:
       (1) Preparing, drafting, and issuing proposed and final 
     regulations or interim regulations.
       (2) Preparing, drafting, and issuing guidance and public 
     information.
       (3) Preparing, drafting, and publishing reports.
       (4) Enforcement of such provisions.
       (5) Reporting, collection, and analysis of data.
       (6) Other administrative duties necessary for 
     implementation of such provisions.
       (c) Transparency of Implementation Funds.--Each Secretary 
     described in subsection (a) shall annually submit, no later 
     than September 1st of each year, to the Committees on Energy 
     and Commerce, on Ways and Means, on Education and Workforce, 
     and on Appropriations of the House of Representatives and on 
     the Committees on Health, Education, Labor, and Pensions and 
     on Appropriations of the Senate a report on funds expended 
     pursuant to funds appropriated under this section.

           TITLE II--REDUCING HEALTH CARE COSTS FOR PATIENTS

     SEC. 201. INCREASING TRANSPARENCY IN GENERIC DRUG 
                   APPLICATIONS.

       (a) In General.--Section 505(j)(3) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355(j)(3)) is amended by 
     adding at the end the following:
       ``(H)(i) Upon request (in controlled correspondence or an 
     analogous process) by a person that has submitted or intends 
     to submit an abbreviated application under this subsection 
     for a drug that is required by regulation to contain one or 
     more of the same inactive ingredients in the same 
     concentrations as the listed drug referred to, or for which 
     the Secretary determines there is a scientific justification 
     for an approach that is in vitro in whole or in part to be 
     used to demonstrate bioequivalence for a drug if such a drug 
     contains one or more of the same inactive ingredients in the 
     same concentrations as the listed drug, the Secretary shall 
     inform the person whether such drug is qualitatively and 
     quantitatively the same as the listed drug. The Secretary may 
     also provide such information to such a person on the 
     Secretary's own initiative during the review of an 
     abbreviated application under this subsection for such drug.
       ``(ii) Notwithstanding section 301(j), if the Secretary 
     determines that such drug is not qualitatively or 
     quantitatively the same as the listed drug, the Secretary 
     shall identify and disclose to the person--
       ``(I) the ingredient or ingredients that cause such drug 
     not to be qualitatively or quantitatively the same as the 
     listed drug; and
       ``(II) for any ingredient for which there is an identified 
     quantitative deviation, the amount of such deviation.
       ``(iii) If the Secretary determines that such drug is 
     qualitatively and quantitatively the same as the listed drug, 
     the Secretary shall not change or rescind such determination 
     after the submission of an abbreviated application for such 
     drug under this subsection unless--
       ``(I) the formulation of the listed drug has been changed 
     and the Secretary has determined that the prior listed drug 
     formulation was withdrawn for reasons of safety or 
     effectiveness; or
       ``(II) the Secretary makes a written determination that the 
     prior determination must be changed because an error has been 
     identified.
       ``(iv) If the Secretary makes a written determination 
     described in clause (iii)(II), the Secretary shall provide 
     notice and a copy of the written determination to the person 
     making the request under clause (i).
       ``(v) The disclosures required by this subparagraph are 
     disclosures authorized by law, including for purposes of 
     section 1905 of title 18, United States Code.''.
       (b) Guidance.--
       (1) In general.--Not later than one year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall issue draft guidance, or update guidance, 
     describing how the Secretary will determine whether a drug is 
     qualitatively and quantitatively the same as the listed drug 
     (as such terms are used in section 505(j)(3)(H) of the 
     Federal Food, Drug, and Cosmetic Act, as added by subsection 
     (a)), including with respect to assessing pH adjusters.

[[Page H6780]]

       (2) Process.--In issuing guidance under this subsection, 
     the Secretary of Health and Human Services shall--
       (A) publish draft guidance;
       (B) provide a period of at least 60 days for comment on the 
     draft guidance; and
       (C) after considering any comments received and not later 
     than one year after the close of the comment period on the 
     draft guidance, publish final guidance.
       (c) Applicability.--Section 505(j)(3)(H) of the Federal 
     Food, Drug, and Cosmetic Act, as added by subsection (a), 
     applies beginning on the date of enactment of this Act, 
     irrespective of the date on which the guidance required by 
     subsection (b) is finalized.

     SEC. 202. IMPROVING TRANSPARENCY AND PREVENTING THE USE OF 
                   ABUSIVE SPREAD PRICING AND RELATED PRACTICES IN 
                   MEDICAID.

       (a) Spread Pricing.--
       (1) In general.--Section 1927(e) of the Social Security Act 
     (42 U.S.C. 1396r-8(e)) is amended by adding at the end the 
     following:
       ``(6) Pharmacy price reimbursement required.--
       ``(A) In general.--A contract between the State and a 
     pharmacy benefit manager (in this paragraph referred to as a 
     `PBM'), or a contract between the State and a designated 
     entity (as defined in subparagraph (C)) that includes 
     provisions making the designated entity responsible for the 
     administration of medical assistance consisting of covered 
     outpatient drugs for individuals enrolled with the designated 
     entity, shall require that payment for such drugs and related 
     administrative services (as applicable), including payments 
     made by a PBM on behalf of the State or designated entity, is 
     based on a pharmacy price reimbursement model under which--
       ``(i) any payment made by the designated entity or the PBM 
     (as applicable) for such a drug--

       ``(I) is limited to--

       ``(aa) ingredient cost; and
       ``(bb) a professional dispensing fee that is not less than 
     the professional dispensing fee that the State plan or waiver 
     would pay if the plan or waiver was making the payment 
     directly;

       ``(II) is passed through in its entirety by the designated 
     entity or PBM to the pharmacy or provider that dispenses the 
     drug and is not retroactively denied or reduced except as 
     permitted or required under Federal or State law or 
     regulation; and
       ``(III) is made in a manner that is consistent with 
     sections 447.502, 447.512, 447.514, and 447.518 of title 42, 
     Code of Federal Regulations (or any successor regulation) as 
     if such requirements applied directly to the designated 
     entity or the PBM, except that any payment by the designated 
     entity or the PBM for the ingredient cost of such a drug 
     purchased by a covered entity (as defined in subsection 
     (a)(5)(B)) may exceed the actual acquisition cost (as defined 
     in section 447.502 of title 42, Code of Federal Regulations 
     (or any successor regulation)) for such drug if--

       ``(aa) such drug was subject to an agreement under section 
     340B of the Public Health Service Act;
       ``(bb) such payment for such cost of such drug does not 
     exceed the maximum payment that would have been made by the 
     designated entity or the PBM for the ingredient cost of such 
     drug had such drug not been purchased by such a covered 
     entity; and
       ``(cc) such covered entity reports to the Secretary, on an 
     annual basis (in a form and manner specified by the 
     Secretary) and with respect to payments for such costs of 
     such drugs so purchased by such covered entity that are in 
     excess of the actual acquisition costs for such drugs, the 
     aggregate amount of such excess;
       ``(ii) payment to the designated entity or the PBM (as 
     applicable) for administrative services performed by the 
     designated entity or PBM is limited to an administrative fee 
     that reflects the fair market value of providing such 
     services;
       ``(iii) the designated entity or the PBM (as applicable) 
     makes available to the State, and the Secretary upon request, 
     all costs and payments related to covered outpatient drugs 
     and accompanying administrative services incurred, received, 
     or made by the designated entity or the PBM, including 
     ingredient costs, professional dispensing fees, 
     administrative fees, post-sale and post-invoice fees, 
     discounts, or related adjustments such as direct and indirect 
     remuneration fees, and any and all other remuneration; and
       ``(iv) any form of spread pricing whereby any amount 
     charged or claimed by the designated entity or the PBM (as 
     applicable) is in excess of the amount paid to the pharmacies 
     by the designated entity or the PBM, including any post-sale 
     or post-invoice fees, discounts, or related adjustments such 
     as direct and indirect remuneration fees or assessments 
     (after allowing for a fair market administrative fee as 
     described in clause (ii)), is not allowable for purposes of 
     claiming Federal matching payments under this title.
       ``(B) Making certain information available.--The Secretary 
     shall publish, not less frequently than on an annual basis, 
     information received by the Secretary pursuant to 
     subparagraph (A)(i)(III)(cc). Such information shall be so 
     published in an electronic and searchable format, such as 
     through the 340B Office of Pharmacy Affairs Information 
     System (or a successor system).
       ``(C) Definitions.--In this paragraph:
       ``(i) Designated entity.--The term `designated entity' 
     means a managed care entity or other specified entity.
       ``(ii) Managed care entity; other specified entity.--The 
     terms `managed care entity' and `other specified entity' have 
     the meaning given such terms in section 1903(m)(9)(D).''.
       (2) Conforming amendments.--Section 1903(m) of such Act (42 
     U.S.C. 1396b(m)) is amended--
       (A) in paragraph (2)(A)(xiii)--
       (i) by striking ``and (III)'' and inserting ``(III)'';
       (ii) by inserting before the period at the end the 
     following: ``, and (IV) with respect to covered outpatient 
     drugs and related administrative services (as applicable) 
     provided by the entity (or by a pharmacy benefit manager on 
     behalf of the entity under a contract or other arrangement 
     with the entity), that payment for such drugs and related 
     administrative services is based on a pharmacy price 
     reimbursement model described in section 1927(e)(6)(A)''; and
       (iii) by moving the margin 2 ems to the left; and
       (B) by adding at the end the following new paragraph:
       ``(10) No payment shall be made under this title to a State 
     with respect to expenditures incurred by it for payment for 
     services provided by an other specified entity (as defined in 
     paragraph (9)(D)) unless the contract between the State and 
     the entity for the provision of such services provides, with 
     respect to covered outpatient drugs and related 
     administrative services (as applicable) provided by the 
     entity (or by a pharmacy benefit manager on behalf of the 
     entity under a contract or other arrangement with the 
     entity), that payment for such drugs and related 
     administrative services is based on a pharmacy price 
     reimbursement model described in section 1927(e)(6)(A).''.
       (3) Effective date.--The amendments made by this subsection 
     apply to contracts between States and pharmacy benefit 
     managers and designated entities (as defined in section 
     1927(e)(6) of the Social Security Act, as added by paragraph 
     (1)) that have an effective date beginning on or after the 
     date that is 18 months after the date of enactment of this 
     Act.
       (b) Ensuring Accurate Payments to Pharmacies Under 
     Medicaid.--
       (1) In general.--Section 1927(f) of the Social Security Act 
     (42 U.S.C. 1396r-8(f)) is amended--
       (A) by striking ``and'' after the semicolon at the end of 
     paragraph (1)(A)(i) and all that precedes it through ``(1)'' 
     and inserting the following:
       ``(1) Determining pharmacy actual acquisition costs.--The 
     Secretary shall conduct a survey of retail community pharmacy 
     drug prices to determine the national average drug 
     acquisition cost as follows:
       ``(A) Use of vendor.--The Secretary may contract services 
     for--
       ``(i) with respect to retail community pharmacies, the 
     determination of retail survey prices of the national average 
     drug acquisition cost for covered outpatient drugs based on a 
     monthly survey of such pharmacies; and'';
       (B) by adding at the end of paragraph (1) the following:
       ``(F) Survey reporting.--A State shall require that any 
     retail community pharmacy in the State that receives any 
     payment, reimbursement, administrative fee, discount, or 
     rebate related to the dispensing of covered outpatient drugs 
     to individuals receiving benefits under this title, 
     regardless of whether such payment, reimbursement, 
     administrative fee, discount, or rebate is received from the 
     State or a designated entity (as defined in subsection 
     (e)(6)(C)) directly or from a pharmacy benefit manager that 
     has a contract with the State or a designated entity, shall 
     respond to surveys of retail prices conducted under this 
     subsection.
       ``(G) Survey information.--Information on national drug 
     acquisition prices obtained under this paragraph shall be 
     made publicly available in a timely manner following the 
     collection of such information and shall include at least the 
     following:
       ``(i) The monthly response rate to the survey including a 
     list of pharmacies not in compliance with subparagraph (F).
       ``(ii) The sampling frame and number of pharmacies sampled 
     monthly.
       ``(iii) Information on price concessions to the pharmacy, 
     including discounts, rebates, and other price concessions, to 
     the extent that such information may be publicly released and 
     is available during the survey period.
       ``(H) Report on specialty pharmacies.--Not later than 1 
     year after the date that this subparagraph takes effect, the 
     Secretary shall submit to Congress a report examining 
     specialty drug coverage and reimbursement under this title, 
     including--
       ``(i) a description of how State Medicaid programs define 
     specialty drugs and specialty pharmacies;
       ``(ii) the amount State Medicaid programs pay for specialty 
     drugs;
       ``(iii) how States and designated entities (as defined in 
     subsection (e)(6)(C)) determine payment for specialty drugs;
       ``(iv) the settings in which specialty drugs are dispensed 
     to individuals receiving benefits under this title (such as 
     retail community pharmacies or specialty pharmacies);
       ``(v) the extent to which specialty drugs (as defined by 
     the respective States) are captured in the national average 
     drug acquisition cost survey (or through another process);

[[Page H6781]]

       ``(vi) examples of specialty drug dispensing fees to 
     support the services associated with dispensing such 
     specialty drugs; and
       ``(vii) recommendations as to whether specialty pharmacies 
     should be included in the survey of retail prices to ensure 
     national average drug acquisition costs capture drugs sold at 
     specialty pharmacies, and how such specialty pharmacies 
     should be defined.
       ``(I) Enforcement.--At the discretion of the Secretary, the 
     Secretary (acting through the Inspector General and in 
     collaboration with the Administrator of the Centers for 
     Medicare & Medicaid Services) may enforce non-compliance with 
     this paragraph by a pharmacy through the establishment of 
     penalties until compliance with this paragraph has been 
     completed.''; and
       (C) in paragraph (2)--
       (i) in subparagraph (A), by inserting ``(including payment 
     rates under managed care organization as defined in section 
     1932(a)(1)(B)(i) and PIHPs and PAHPs as defined in section 
     1903(m)(9)(D)(iii)(I) and (II), respectively)'' after ``under 
     this title''; and
       (ii) in subparagraph (B), by inserting ``, and the basis 
     for such dispensing fees'' before the semicolon at the end.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect on the first day of the first quarter that 
     begins on or after the date that is 18 months after the date 
     of enactment of this Act.

     SEC. 203. PARITY IN MEDICARE PAYMENTS FOR HOSPITAL OUTPATIENT 
                   DEPARTMENT SERVICES FURNISHED OFF-CAMPUS.

       (a) In General.--Section 1833(t)(16) of the Social Security 
     Act (42 U.S.C. 1395l(t)(16)) is amended by adding at the end 
     the following new subparagraph:
       ``(H) Parity in fee schedule amount for certain services 
     furnished by an off-campus outpatient department of a 
     provider.--
       ``(i) In general.--Subject to clause (iii), in the case of 
     specified OPD services (as defined in clause (v)) that are 
     furnished during 2025 or a subsequent year by an off-campus 
     outpatient department of a provider (as defined in clause 
     (iv)) (or, in the case of an off-campus outpatient department 
     of a provider that is a hospital described in section 
     1886(d)(1)(B)(v), or is located in a rural area or a health 
     professional shortage area, such services that are furnished 
     during 2026 or a subsequent year), there shall be substituted 
     for the amount otherwise determined under this subsection for 
     such service and year an amount equal to the payment amount 
     that would have been payable under the applicable payment 
     system under this part (other than under this subsection) had 
     such services been furnished by such a department subject to 
     such payment system pursuant to paragraph (21)(C).
       ``(ii) Not budget neutral implementation.--In making any 
     budget neutrality adjustments under this subsection for 2025 
     or a subsequent year, the Secretary shall not take into 
     account the reduced expenditures that result from the 
     application of this subparagraph.
       ``(iii) Transition.--The Secretary shall provide for a 4-
     year phase-in of the application of clause (i), with clause 
     (i) being fully applicable for specified OPD services 
     beginning with 2028 (or in the case of an off-campus 
     outpatient department of a provider that is a hospital 
     described in section 1886(d)(1)(B)(v), or is located in a 
     rural area or a health professional shortage area, beginning 
     with 2029).
       ``(iv) Off-campus department of a provider.--For purposes 
     of this subparagraph, the term `off-campus outpatient 
     department of a provider' means a department of a provider 
     (as defined in section 413.65(a)(2) of title 42, Code of 
     Federal Regulations) that is not located--

       ``(I) on the campus (as such term is defined in such 
     section) of such provider; or
       ``(II) within the distance (described in such definition of 
     campus) from a remote location of a hospital facility (as 
     defined in such section).

       ``(v) Other definitions.--For purposes of this 
     subparagraph:

       ``(I) Designated ambulatory payment classification group.--
     The term `designated ambulatory payment classification group' 
     means an ambulatory payment classification group for drug 
     administration services.
       ``(II) Health professional shortage area.--The term `health 
     professional shortage area' has the meaning given such term 
     in section 332(a)(1)(A) of the Public Health Service Act.
       ``(III) Rural area.--The term `rural area' has the meaning 
     given such term in section 1886(d)(2)(D).
       ``(IV) Specified opd services.--The term `specified OPD 
     services' means covered OPD services assigned to a designated 
     ambulatory payment classification group.''.

       (b) Implementation.--Section 1833(t)(12) of the Social 
     Security Act (42 U.S.C. 1395l(t)(12)) is amended--
       (1) in subparagraph (D), by striking ``and'' at the end;
       (2) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(F) the determination of any payment amount under 
     paragraph (16)(H), including the transition under clause 
     (iii) of such paragraph.''.

     SEC. 204. REQUIRING A SEPARATE IDENTIFICATION NUMBER AND AN 
                   ATTESTATION FOR EACH OFF-CAMPUS OUTPATIENT 
                   DEPARTMENT OF A PROVIDER.

       (a) In General.--Section 1833(t) of the Social Security Act 
     (42 U.S.C. 1395l(t)) is amended by adding at the end the 
     following new paragraph:
       ``(23) Use of unique health identifiers; attestation.--
       ``(A) In general.--No payment may be made under this 
     subsection (or under an applicable payment system pursuant to 
     paragraph (21)) for items and services furnished on or after 
     January 1, 2026, by an off-campus outpatient department of a 
     provider (as defined in subparagraph (C)) unless--
       ``(i) such department has obtained, and such items and 
     services are billed under, a standard unique health 
     identifier for health care providers (as described in section 
     1173(b)) that is separate from such identifier for such 
     provider; and
       ``(ii) such provider has submitted to the Secretary, during 
     the 2-year period ending on the date such items and services 
     are so furnished, an attestation that such department is 
     compliant with the requirements described in section 413.65 
     of title 42, Code of Federal Regulations (or a successor 
     regulation).
       ``(B) Process for submission and review.--Not later than 1 
     year after the date of enactment of this paragraph, the 
     Secretary shall, through notice and comment rulemaking, 
     establish a process for each provider with an off-campus 
     outpatient department of a provider to submit an attestation 
     pursuant to subparagraph (A)(ii), and for the Secretary to 
     review each such attestation and determine, through site 
     visits, remote audits, or other means (as determined 
     appropriate by the Secretary), whether such department is 
     compliant with the requirements described in such 
     subparagraph.
       ``(C) Off-campus outpatient department of a provider 
     defined.--For purposes of this paragraph, the term `off-
     campus outpatient department of a provider' means a 
     department of a provider (as defined in section 413.65 of 
     title 42, Code of Federal Regulations, or any successor 
     regulation) that is not located--
       ``(i) on the campus (as defined in such section) of such 
     provider; or
       ``(ii) within the distance (described in such definition of 
     campus) from a remote location of a hospital facility (as 
     defined in such section).''.
       (b) HHS OIG Analysis.--Not later than January 1, 2030, the 
     Inspector General of the Department of Health and Human 
     Services shall submit to Congress--
       (1) an analysis of the process established by the Secretary 
     of Health and Human Services to conduct the reviews and 
     determinations described in section 1833(t)(23)(B) of the 
     Social Security Act, as added by subsection (a) of this 
     section; and
       (2) recommendations based on such analysis, as the 
     Inspector General determines appropriate.

 TITLE III--SUPPORTING PATIENTS, HEALTH CARE WORKERS, COMMUNITY HEALTH 
                         CENTERS, AND HOSPITALS

     SEC. 301. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE 
                   NATIONAL HEALTH SERVICE CORPS, AND TEACHING 
                   HEALTH CENTERS THAT OPERATE GME PROGRAMS.

       (a) Teaching Health Centers That Operate Graduate Medical 
     Education Programs.--
       (1) Addition to capped amounts for fiscal years 2024 and 
     2025.--Paragraph (2) of section 340H(b) of the Public Health 
     Service Act (42 U.S.C. 256h(b)) is amended by adding at the 
     end the following:
       ``(C) Addition.--Notwithstanding any provision of this 
     section, for each of fiscal years 2024 and 2025, the 
     Secretary may use any amounts made available in any fiscal 
     year to carry out this section (including amounts recouped 
     under subsection (f)) to make payments described in 
     paragraphs (1)(A) and (1)(B), in addition to the total amount 
     of funds appropriated under subsection (g).''.
       (2) Reconciliation.--Section 340H(f) of the Public Health 
     Service Act (42 U.S.C. 256h(f)) is amended--
       (A) by striking ``The Secretary shall determine'' and 
     inserting the following:
       ``(1) Determination.--The Secretary shall determine''; and
       (B) by adding at the end the following:
       ``(2) Annual report to congress.--For each fiscal year, the 
     Secretary shall submit to the Committee on Energy and 
     Commerce of the House of Representatives and the Committee on 
     Health, Education, Labor, and Pensions of the Senate a report 
     specifying--
       ``(A) the total amount of funds recouped under paragraph 
     (1);
       ``(B) the rationale for the funds being recouped; and
       ``(C) in the case of the reports for each of fiscal years 
     2024 and 2025, the total amount of funds recouped under 
     paragraph (1) that were used pursuant to subsection (b)(2)(C) 
     to adjust total payment amounts above the total amounts 
     appropriated under subsection (g).''.
       (3) Funding.--Section 340H(g) of the Public Health Service 
     Act (42 U.S.C. 256h(g)) is amended--
       (A) by amending paragraph (1) to read as follows:
       ``(1) In general.--To carry out this section, there are 
     appropriated such sums as may be necessary, not to exceed--
       ``(A) $230,000,000, for the period of fiscal years 2011 
     through 2015;
       ``(B) $60,000,000 for each of fiscal years 2016 and 2017;

[[Page H6782]]

       ``(C) $126,500,000 for each of fiscal years 2018 through 
     2023;
       ``(D) $16,635,616 for the period beginning on October 1, 
     2023, and ending on November 17, 2023;
       ``(E) $21,834,247 for the period beginning on November 18, 
     2023, and ending on January 19, 2024;
       ``(F) $136,530,137 for the period beginning on January 20, 
     2024, and ending on September 30, 2024;
       ``(G) $175,000,000 for fiscal year 2025;
       ``(H) $225,000,000 for each of fiscal years 2026 and 2027; 
     and
       ``(I) $300,000,000 for each of fiscal years 2028, 2029, and 
     2030.''; and
       (B) by adding at the end the following:
       ``(3) Availability.--The amounts made available under 
     paragraph (1) shall remain available until expended.''.
       (b) Extension for Community Health Centers.--Section 
     10503(b)(1)(F) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 254b-2(b)(1)(F)) is amended--
       (1) by striking ``and'' before ``$690,410,959''; and
       (2) by inserting ``, $3,183,561,644 for the period 
     beginning on January 20, 2024, and ending on September 30, 
     2024, $4,400,000,000 for fiscal year 2025, and $1,109,000,000 
     for the period beginning October 1, 2025, and ending December 
     31, 2025'' before the semicolon at the end.
       (c) Extension for the National Health Service Corps.--
     Section 10503(b)(2) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 254b-2(b)(2)) is amended--
       (1) in subparagraph (H), by striking ``and'' at the end;
       (2) in subparagraph (I), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(J) $255,726,028 for the period beginning on January 20, 
     2024, and ending on September 30, 2024, $350,000,000 for 
     fiscal year 2025, and $88,219,178 for the period beginning 
     October 1, 2025, and ending December 31, 2025.''.
       (d) Government Accountability Office Report.--
       (1) In general.--Not later than one year after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to the Committee on Energy and Commerce 
     of the House of Representatives and the Committee on Health, 
     Education, Labor, and Pensions of the Senate a report 
     assessing the effectiveness of the National Health Service 
     Corps at attracting health care professionals to HPSAs, 
     including by--
       (A) assessing the metrics used by the Health Resources and 
     Services Administration in evaluating the program;
       (B) comparing the retention rates of NHSC participants in 
     the HPSAs where they completed their period of obligated 
     service to the retention rate of non-NHSC participants in the 
     corresponding HPSAs;
       (C) comparing the retention rates of NHSC participants in 
     the HPSAs where they completed their period of obligated 
     service to the retention rates of NHSC participants in HPSAs 
     other than those where they completed their period of 
     obligated service;
       (D) identifying factors that influence a NHSC participant's 
     decision to practice in a HPSA other than the HPSA where they 
     completed their period of obligated service;
       (E) identifying factors other than participation in the 
     National Health Service Corps Scholarship and Loan Repayment 
     Programs that attract health care professionals to a HPSA;
       (F) assessing the impact the National Health Service Corps 
     has on wages for health care professionals in a HPSA; and
       (G) comparing the distribution of NHSC participants across 
     HPSAs, including a comparison of rural versus non-rural 
     HPSAs.
       (2) Definition.--In this section:
       (A) The term ``HPSA'' means a health professional shortage 
     area designated under section 332 of the Public Health 
     Service Act (42 U.S.C. 254e).
       (B) The term ``NHSC participant'' means a National Health 
     Service Corps member participating in the National Health 
     Service Corps Scholarship or Loan Repayment Program.
       (e) Application of Provisions.--Amounts appropriated 
     pursuant to the amendments made by this section shall be 
     subject to the requirements contained in Public Law 117-328 
     for funds for programs authorized under sections 330 through 
     340 of the Public Health Service Act.
       (f) Conforming Amendment.--Paragraph (4) of section 3014(h) 
     of title 18, United States Code, is amended by striking ``and 
     section 2321(d) of the Continuing Appropriations Act, 2024 
     and Other Extensions Act'' and inserting ``section 2321(d) of 
     the Continuing Appropriations Act, 2024 and Other Extensions 
     Act, and section 301(e) of the Lower Costs, More Transparency 
     Act''.

     SEC. 302. EXTENSION OF SPECIAL DIABETES PROGRAMS.

       (a) Extension of Special Diabetes Programs for Type I 
     Diabetes.--Section 330B(b)(2) of the Public Health Service 
     Act (42 U.S.C. 254c-2(b)(2)) is amended--
       (1) in subparagraph (D), by striking ``and'' at the end;
       (2) in subparagraph (E), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following:
       ``(F) $124,383,562 for the period beginning on January 20, 
     2024, and ending on September 30, 2024, to remain available 
     until expended;
       ``(G) $170,000,000 for fiscal year 2025, to remain 
     available until expended; and
       ``(H) $42,849,315 for the period beginning October 1, 2025, 
     and ending December 31, 2025, to remain available until 
     expended.''.
       (b) Extending Funding for Special Diabetes Programs for 
     Indians.--Section 330C(c)(2) of the Public Health Service Act 
     (42 U.S.C. 254c-3(c)(2)) is amended--
       (1) in subparagraph (D), by striking ``and'' at the end;
       (2) in subparagraph (E), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following:
       ``(F) $124,383,562 for the period beginning on January 20, 
     2024, and ending on September 30, 2024, to remain available 
     until expended;
       ``(G) $170,000,000 for fiscal year 2025, to remain 
     available until expended; and
       ``(H) $42,849,315 for the period beginning October 1, 2025, 
     and ending December 31, 2025, to remain available until 
     expended.''.

     SEC. 303. DELAYING CERTAIN DISPROPORTIONATE SHARE PAYMENT 
                   CUTS.

       Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 
     1396r-4(f)(7)(A)) is amended--
       (1) in clause (i)--
       (A) by striking ``For the period beginning January 20, 
     2024, and ending September 30, 2024, and for each of fiscal 
     years 2025'' and inserting ``For each of fiscal years 2026''; 
     and
       (B) by striking ``or period'' each place such term appears; 
     and
       (2) in clause (ii), by striking ``for the period beginning 
     January 20, 2024, and ending September 30, 2024, and for each 
     of fiscal years 2025'' and inserting ``for each of fiscal 
     years 2026''.

     SEC. 304. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(3)(A) of the Social Security Act (42 U.S.C. 
     1396w-1(b)(3)(A)) is amended by striking `` $6,357,117,810'' 
     and inserting ``$0''.

TITLE IV--INCREASING ACCESS TO QUALITY HEALTH DATA AND LOWERING HIDDEN 
                                  FEES

     SEC. 401. INCREASING PLAN FIDUCIARIES' ACCESS TO HEALTH DATA.

       (a) Plan Fiduciary Access to Information.--
       (1) In general.--Paragraph (2) of section 408(b) of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1108(b)) is amended by adding at the end the following new 
     subparagraph:
       ``(C) No contract or arrangement for services between a 
     group health plan and any other entity, including a health 
     care provider (including a health care facility), network or 
     association of providers, service provider offering access to 
     a network of providers, third-party administrator, or 
     pharmacy benefit manager, is reasonable within the meaning of 
     this paragraph unless such contract or arrangement--
       ``(i) allows the responsible plan fiduciary (as defined in 
     subparagraph (B)(ii)(I)(ee)) to audit or review all de-
     identified claims and encounter information or data described 
     in section 724(a)(1)(B) to--
       ``(I) ensure that such entity complies with the terms of 
     the plan and any applicable law; and
       ``(II) determine the reasonableness of compensation 
     received by such entity; and
       ``(ii) does not--
       ``(I) unreasonably limit the number of audits permitted 
     during a given period of time;
       ``(II) limit the number of de-identified claims and 
     encounter information or data that the responsible plan 
     fiduciary may access during an audit;
       ``(III) limit the disclosure of pricing terms for value-
     based payment arrangements or capitated payment arrangements, 
     including--

       ``(aa) payment calculations and formulas;
       ``(bb) quality measures;
       ``(cc) contract terms;
       ``(dd) payment amounts;
       ``(ee) measurement periods for all incentives; and
       ``(ff) other payment methodologies used by an entity, 
     including a health care provider (including a health care 
     facility), network or association of providers, service 
     provider offering access to a network of providers, third-
     party administrator, or pharmacy benefit manager;

       ``(IV) limit the disclosure of overpayments and overpayment 
     recovery terms;
       ``(V) limit the right of the responsible plan fiduciary to 
     select an auditor;
       ``(VI) otherwise limit or unduly delay by greater than 60 
     calendar days after the date of request the responsible plan 
     fiduciary from auditing all de-identified claims and 
     encounter information or data; or
       ``(VII) permit the entity to charge a fee beyond the 
     reasonable direct costs to provide the required information 
     and otherwise comply and assist with an audit request.''.
       (2) Civil enforcement.--
       (A) In general.--Subsection (c) of section 502 of such Act 
     (29 U.S.C. 1132) is amended by adding at the end the 
     following new paragraph:
       ``(13) In the case of an agreement between a group health 
     plan and a health care provider (including a health care 
     facility), network or association of providers, service 
     provider offering access to a network of providers, third-
     party administrator, or pharmacy benefit manager, that 
     violates the provisions of section 724, the Secretary may 
     assess a civil penalty against such provider, network or 
     association, service provider offering access to a network of 
     providers, third-party administrator, pharmacy benefit 
     manager, or other service provider in the

[[Page H6783]]

     amount of $10,000 for each day during which such violation 
     continues. Such penalty shall be in addition to other 
     penalties as may be prescribed by law.''.
       (B) Conforming amendment.--Paragraph (6) of section 502(a) 
     of such Act is amended by striking ``or (9)'' and inserting 
     ``(9), or (13)''.
       (3) Existing provisions void.--Section 410 of such Act is 
     amended by adding at the end the following new subsection:
       ``(c) Any provision in an agreement or instrument shall be 
     void as against public policy if such provision--
       ``(1) unduly delays or limits a plan fiduciary from 
     accessing the de-identified claims and encounter information 
     or data described in section 724(a)(1)(B); or
       ``(2) violates the requirements of section 408(b)(2)(C).''.
       (b) Updated Attestation for Price and Quality 
     Information.--Section 724(a)(3) of the Employee Retirement 
     Income Security Act (29 U.S.C. 1185m(a)(3)) is amended to 
     read as follows:
       ``(3) Attestation.--
       ``(A) In general.--Subject to subparagraph (C), the plan 
     fiduciary of a group health plan or health insurance issuer 
     offering group health insurance coverage shall annually 
     submit to the Secretary an attestation that such plan or 
     issuer of such coverage is in compliance with the 
     requirements of this subsection. Such attestation shall also 
     include a statement verifying that--
       ``(i) the information or data described under subparagraphs 
     (A) and (B) of paragraph (1) is available upon request and 
     provided to the plan fiduciary, the plan administrator, or 
     the issuer in a timely manner; and
       ``(ii) there are no terms in the agreement under such 
     paragraph (1) that directly or indirectly restrict or unduly 
     delay a plan fiduciary, the plan administrator, or the issuer 
     from auditing, reviewing, or otherwise accessing such 
     information, except as permitted under section 408(b)(2)(C).
       ``(B) Limitation on submission.--Subject to clause (ii), a 
     group health plan or issuer offering group health insurance 
     coverage may not enter into an agreement with a third-party 
     administrator or other service provider to submit the 
     attestation required under subparagraph (A).
       ``(C) Exception.--In the case of a group health plan or 
     issuer offering group health insurance coverage that is 
     unable to obtain the information or data needed to submit the 
     attestation required under subparagraph (A), such plan or 
     issuer may submit a written statement in lieu of such 
     attestation that includes--
       ``(i) an explanation of why such plan or issuer was 
     unsuccessful in obtaining such information or data, including 
     whether such plan or issuer was limited or prevented from 
     auditing, reviewing, or otherwise accessing such information 
     or data;
       ``(ii) a description of the efforts made by the plan 
     fiduciary to remove any gag clause provisions from the 
     agreement under paragraph (1); and
       ``(iii) a description of any response by the third-party 
     administrator or other service provider with respect to 
     efforts to comply with the attestation requirement under 
     subparagraph (A).''.
       (c) Report on Plan Assets.--Not later than 1 year after the 
     date of enactment of this Act, the Secretary of Labor shall 
     submit to the Committee on Education and the Workforce of the 
     House of Representatives and the Committee on Health, 
     Education, Labor, and Pensions of the Senate a report on the 
     status of de-identified claims and encounter information or 
     data described in section 724(a)(1)(B) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1185m), 
     including information on the following:
       (1) Whether changes to regulations or guidance would permit 
     such information or data to be deemed a group health plan 
     asset (as defined under section 3(42) of such Act).
       (2) Whether restrictions on the ability of a plan fiduciary 
     to access such information or data violates a requirement of 
     current law.
       (3) The existing regulatory authority of the Secretary to 
     clarify whether such information or data is the property of a 
     group health plan, rather than a service provider.
       (4) Legislative recommendations to establish that such 
     information or data related to a plan belongs to a group 
     health plan and is handled in the best interests of plan 
     participants and beneficiaries.
       (d) Effective Date.--The amendments made by subsections (a) 
     and (b) shall apply with respect to a plan beginning with the 
     first plan year that begins on or after the date that is 1 
     year after the date of enactment of this Act.

     SEC. 402. HIDDEN FEES DISCLOSURE REQUIREMENTS.

       (a) Clarification of the Application of Fee Disclosure 
     Requirements to Covered Service Providers.--
       (1) Services.--Clause (ii)(I)(bb) of section 408(b)(2)(B) 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1108(b)(2)(B)) is amended--
       (A) in subitem (AA) by striking ``Brokerage services,'' and 
     inserting ``Services (including brokerage services),''; and
       (B) in subitem (BB)--
       (i) by striking ``Consulting,'' and inserting ``Other 
     services,''; and
       (ii) by inserting ``any of the following:'' before ``plan 
     design''.
       (2) Disclosures.--Clause (iii)(III) of section 408(b)(2)(B) 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1108(b)(2)(B)) is amended by striking ``, either in 
     the aggregate or by service,'' and inserting ``by service''.
       (b) Strengthening Disclosure Requirements With Respect to 
     Pharmacy Benefit Managers and Third Party Administrators for 
     Group Health Plans.--
       (1) Certain arrangements for pharmacy benefit manager 
     services considered as indirect.--
       (A) In general.--Clause (i) of section 408(b)(2)(B) of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1108(b)(2)(B)) is amended--
       (i) by striking ``requirements of this clause'' and 
     inserting ``requirements of this subparagraph''; and
       (ii) by adding at the end the following: ``For purposes of 
     applying section 406(a)(1)(C) with respect to a transaction 
     described under this subparagraph, a contract or arrangement 
     for services between a covered plan and a health insurance 
     issuer providing health insurance coverage in connection with 
     the covered plan in which the health insurance issuer 
     contracts, in connection with such plan, with a service 
     provider for pharmacy benefit management services shall be 
     considered to constitute an indirect furnishing of goods, 
     services, or facilities between the plan and the service 
     provider acting as the party in interest.''.
       (B) Health insurance issuer and health insurance coverage 
     defined.--Clause (ii)(I)(aa) of section 408(b)(2)(B) of such 
     Act (29 U.S.C. 1108(b)(2)(B)) is amended by inserting before 
     the period at the end ``and the terms `health insurance 
     coverage' and `health insurance issuer' have the meanings 
     given such terms in section 733(b)''.
       (C) Technical amendment.--Clause (ii)(I)(aa) of section 
     408(b)(2)(B) of the Employee Retirement Income Security Act 
     of 1974 (29 U.S.C. 1108(b)(2)(B)) is further amended by 
     inserting ``in'' after ``defined''.
       (2) Specific disclosure requirements with respect to 
     pharmacy benefit management services.--
       (A) In general.--Clause (iii) of section 408(b)(2)(B) of 
     such Act (29 U.S.C. 1108(b)(2)(B)) is amended by adding at 
     the end the following:
       ``(VII) With respect to a contract or arrangement with the 
     covered plan in connection with the provision of pharmacy 
     benefit management services, as part of the description 
     required under subclauses (III) and (IV)--
       ``(aa) all compensation described in clause 
     (ii)(I)(dd)(AA), including fees, rebates, alternative 
     discounts, co-payment offsets, and other remuneration 
     expected to be received by the covered service provider, an 
     affiliate, or a subcontractor from a pharmaceutical 
     manufacturer, distributor, rebate aggregator, accumulator, 
     and maximizer, group purchasing organization, or any other 
     third party;
       ``(bb) the amount and form of any rebates, discounts, or 
     price concessions, including the amount expected to be passed 
     through to the plan sponsor or the participants and 
     beneficiaries under the covered plan;
       ``(cc) all compensation expected to be received by the 
     covered service provider, an affiliate, or a subcontractor as 
     a result of paying a lower amount for the drug than the 
     amount charged as a copayment, coinsurance amount, or 
     deductible;
       ``(dd) all compensation expected to be received by the 
     covered service provider, an affiliate, or a subcontractor as 
     a result of paying pharmacies less than what is charged the 
     health plan, plan sponsor, or participants and beneficiaries 
     under the covered plan; and
       ``(ee) all compensation expected to be received by the 
     covered service provider, an affiliate, or a subcontractor 
     from drug manufacturers and any other third party in exchange 
     for--

       ``(AA) administering, invoicing, allocating, or collecting 
     rebates related to the covered plan;
       ``(BB) providing business services and activities, 
     including providing access to drug utilization data;
       ``(CC) keeping a percentage of the list price of a drug; or
       ``(DD) any other reason related to the role of a covered 
     service provider as a conduit between the drug manufacturers 
     or any other third party and the covered plan.''.

       (B) Annual disclosure.--Clause (v) of section 408(b)(2)(B) 
     of such Act (29 U.S.C. 1108(b)(2)(B)) is amended by adding at 
     the end the following:
       ``(III) A covered service provider, with respect to a 
     contract or arrangement with the covered plan in connection 
     with providing pharmacy benefit management services, shall 
     disclose, on an annual basis not later than 60 days after the 
     beginning of the current plan year, to a responsible plan 
     fiduciary, in writing, the following with respect to the 
     twelve months preceding the current plan year:
       ``(aa) All direct compensation described in subclause (III) 
     of clause (iii) and indirect compensation described in 
     subclause (IV) of clause (iii) received by the covered 
     service provider (including such compensation described in 
     subclause (VII) of clause (iii)).
       ``(bb) The total gross spending by the covered plan on 
     drugs (excluding rebates, discounts, or other price 
     concessions).
       ``(cc) The total net spending by the covered plan on drugs.
       ``(dd) The total gross spending at all pharmacies wholly or 
     partially owned by the covered service provider or any entity 
     affiliated with the covered service provider, including

[[Page H6784]]

     mail-order, specialty and retail pharmacies, with a breakdown 
     by individual pharmacy location.
       ``(ee) The aggregate amount of clawback from such 
     pharmacies, including mail-order, specialty, and retail 
     pharmacies.

       ``(AA) categorical explanations (grouped by the reason for 
     clawback, such as contractual true-up provisions, 
     overpayments, or non-covered medication dispensed, and 
     including information on the amount in each category that was 
     passed through to the covered plan and to participants and 
     beneficiaries of the covered plan); or
       ``(BB) individual explanations for such clawbacks.

       ``(ff) Total aggregate amounts of fees collected by the 
     covered service provider, an affiliate, or a subcontractor in 
     connection with the provision of pharmacy benefit management 
     services to the covered plan.
       ``(gg) Any other information specified by the Secretary 
     through regulations or guidance that may be necessary for a 
     responsible plan fiduciary to consider the merits of the 
     contract or arrangement with the covered service provider and 
     any conflicts of interest that may exist.''.
       (C) Pharmacy benefit management services defined.--Clause 
     (ii)(I) of section 408(b)(2)(B) of such Act (29 U.S.C. 
     1108(b)(2)(B)) is amended by adding at the end the following:
       ``(gg) The term `pharmacy benefit management services' 
     includes any services provided by a covered service provider 
     to a covered plan with respect to the administration of 
     prescription drug benefits under the covered plan, 
     including--

       ``(AA) processing and payment of claims;
       ``(BB) design of pharmacy networks;
       ``(CC) negotiation, aggregation, and distribution of 
     rebates, discounts, and other price concessions;
       ``(DD) formulary design and maintenance;
       ``(EE) operation of pharmacies (whether retail, mail order, 
     specialty drug, or otherwise);
       ``(FF) recordkeeping;
       ``(GG) utilization review;
       ``(HH) adjudication of claims; and
       ``(II) any other services specified by the Secretary 
     through guidance or rulemaking.''.

       (D) Clawback defined.--Clause (ii)(I) of section 
     408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)), as 
     amended by subparagraph (C), is amended by adding at the end 
     the following:
       ``(hh) The term `clawback' means amounts collected by a 
     provider of pharmacy benefit management services from a 
     pharmacy for copayments collected from a participant or 
     beneficiary in excess of the contracted rate.''.
       (3) Specific disclosure requirements with respect to third 
     party administration services for group health plans.--
       (A) In general.--Clause (iii) of section 408(b)(2)(B) of 
     such Act (29 U.S.C. 1108(b)(2)(B)), as amended by paragraph 
     (2)(A), is further amended by adding at the end the 
     following:
       ``(VIII) With respect to a contract or arrangement with the 
     covered plan in connection with the provision of third party 
     administration services for group health plans, as part of 
     the description required under subclauses (III) and (IV)--
       ``(aa) the amount and form of any rebates, discounts, 
     savings fees, refunds, or amounts received from providers and 
     facilities, including the amounts that will be retained by 
     the covered service provider as a fee;
       ``(bb) the amount and form of fees expected to be received 
     from other service providers in relation to the covered plan, 
     including the amounts that will be retained by the covered 
     service provider as a fee; and
       ``(cc) the amount and form of expected recoveries by the 
     covered service provider, including the amounts that will be 
     retained by the covered service provider as a fee 
     (disaggregated by category), as a result of--

       ``(AA) overpayments;
       ``(BB) erroneous payments;
       ``(CC) uncashed checks or incomplete payments;
       ``(DD) billing errors;
       ``(EE) subrogation;
       ``(FF) fraud; or
       ``(GG) any other reason on behalf of the covered plan.''.

       (B) Annual disclosure.--Clause (v) of section 408(b)(2)(B) 
     of such Act (29 U.S.C. 1108(b)(2)(B)), as amended by 
     paragraph (2)(B), is amended by adding at the end the 
     following:
       ``(IV) A covered service provider, with respect to a 
     contract or arrangement with the covered plan in connection 
     with providing third party administration services for group 
     health plans, shall disclose, on an annual basis not later 
     than 60 days after the beginning of the current plan year, to 
     a responsible plan fiduciary, in writing, the following with 
     respect to the twelve months preceding the current plan year:
       ``(aa) All direct compensation described in subclause (III) 
     of clause (iii).
       ``(bb) All indirect compensation described in subclause 
     (IV) of clause (iii) received by the covered service 
     provider, an affiliate, or a subcontractor (including such 
     compensation described in subclause (VIII) of clause (iii)).
       ``(cc) The aggregate amount for which the covered service 
     provider, an affiliate, or a subcontractor received indirect 
     compensation and the estimated amount of cost-sharing 
     incurred by plan participants and beneficiaries as a result.
       ``(dd) The total gross spending by the covered plan on all 
     costs and fees arising under or paid under the administrative 
     services agreement with the covered service provider (not 
     including any amounts described in items (aa) through (cc) of 
     clause (iii)(VIII)).
       ``(ee) The total net spending by the covered plan on all 
     costs and fees arising under or paid under the administrative 
     services agreement with the covered service provider.
       ``(ff) The aggregate fees collected by the covered service 
     provider, an affiliate, or a subcontractor.
       ``(gg) Any other information specified by the Secretary 
     through regulations or guidance that may be necessary for a 
     responsible plan fiduciary to consider the merits of the 
     contract or arrangement with the covered service provider and 
     any conflicts of interest that may exist.''.
       (C) Third party administration services for group health 
     plans defined.--Clause (ii)(I) of section 408(b)(2)(B) of 
     such Act (29 U.S.C. 1108(b)(2)(B)), as amended by paragraph 
     (2)(C), is amended by adding at the end the following:
       ``(ii) The term `third party administration services for 
     group health plans' includes any services provided by a 
     covered service provider, an affiliate, or a subcontractor to 
     a covered plan with respect to the administration of health 
     benefits under the covered plan, including--

       ``(AA) the processing, repricing, and payment of claims;
       ``(BB) design, creation, and maintenance of provider 
     networks;
       ``(CC) negotiation of discounts off gross rates;
       ``(DD) benefit and plan design;
       ``(EE) negotiation of payment rates;
       ``(FF) recordkeeping;
       ``(GG) utilization review;
       ``(HH) adjudication of claims;
       ``(II) regulatory compliance; and
       ``(JJ) any other services set forth in an administrative 
     services agreement or similar agreement or specified by the 
     Secretary through rulemaking.''.

       (4) Rule of construction.--Nothing in the amendments made 
     by this section shall be construed to imply that a practice 
     in relation to which a covered service provider is required 
     to provide information as a result of such amendments is 
     permissible under Federal law.
       (5) Effective date.--No contract or arrangement entered 
     into prior to January 1, 2025, shall be subject to the 
     requirements of subsection (b).
       (c) Privacy Requirements.--Section 408(b)(2) of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1108(b)(2)), as amended by section 401, is further amended by 
     adding at the end the following:
       ``(D) Privacy requirements.--Covered service providers 
     shall provide information under subparagraph (B) in a manner 
     consistent with the privacy, security, and breach 
     notification regulations promulgated under section 13402(a) 
     of the Health Information Technology for Clinical Health Act 
     (42 U.S.C. 17932(a)), and consistent with the HIPAA privacy 
     regulations (as defined in section 1180(b)(3) of the Social 
     Security Act) and shall restrict the use and disclosure of 
     such information according to such privacy, security, and 
     breach notification regulations and such HIPAA privacy 
     regulations.
       ``(E) Disclosure and redisclosure.--
       ``(i) Limitation to business associates.--A responsible 
     plan fiduciary receiving information disclosed under 
     subparagraph (B) may disclose such information only to the 
     entity from which the information was received, the group 
     health plan for which the information pertains, or to that 
     entity's business associates as defined in section 160.103 of 
     title 45, Code of Federal Regulations (or successor 
     regulations) or as permitted by the HIPAA Privacy Rule (45 
     CFR parts 160 and 164, subparts A and E).
       ``(ii) Clarification regarding public disclosure of 
     information.--Nothing in this section shall prevent a group 
     health plan or health insurance issuer offering group health 
     insurance coverage, or a covered service provider, from 
     placing reasonable restrictions on the public disclosure of 
     the information described in this subparagraph, except that 
     such plan, issuer, or entity may not restrict disclosure of 
     such information to the Department of Labor.
       ``(F) Additional privacy requirements.--
       ``(i) In general.--Covered service providers shall ensure 
     that information provided under subparagraph (B) contains 
     only summary health information, as defined in section 
     164.504(a) of title 45, Code of Federal Regulations (or 
     successor regulations).
       ``(ii) Restrictions.--A group health plan must comply with 
     section 164.504(f) of title 45, Code of Federal Regulations 
     and a responsible plan administrator who is a plan sponsor 
     must act in accordance with the terms of the agreement 
     described in such section.
       ``(G) Rule of construction.--Nothing in this section shall 
     be construed to modify the requirements for the creation, 
     receipt, maintenance, or transmission of protected health 
     information under the HIPAA privacy regulations (as defined 
     in section 1180(b)(3) of the Social Security Act).''.
       (d) Implementation.--Not later than 1 year after the date 
     of enactment of this Act, the Secretary of Labor shall issue 
     notice and comment rulemaking as necessary to implement the 
     provisions of this section. The Secretary shall ensure that 
     such rulemaking--

[[Page H6785]]

       (1) accounts for the varied compensation practices of 
     covered service providers (as defined under section 
     408(b)(2)(B); and
       (2) establishes standards for the disclosure of expected 
     compensation by such covered service providers.

     SEC. 403. PRESCRIPTION DRUG PRICE INFORMATION REQUIREMENT.

       (a) PHSA.--
       (1) In general.--Part D of title XXVII of the Public Health 
     Service Act, as amended by section 106, is further amended by 
     adding at the end the following new section:

     ``SEC. 2799A-12. INFORMATION ON PRESCRIPTION DRUGS.

       ``(a) In General.--A group health plan or a health 
     insurance issuer offering group or individual health 
     insurance coverage shall--
       ``(1) not restrict, directly or indirectly, any pharmacy 
     that dispenses a prescription drug to an enrollee in the plan 
     or coverage from informing (or penalize such pharmacy for 
     informing) an enrollee of any differential between the 
     enrollee'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 group 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) an 
     enrollee of any differential between the enrollee's out-of-
     pocket cost under such 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 group 
     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 enrollee under the plan or 
     coverage, including any cost-sharing (including any 
     deductible, copayment, or coinsurance) and, as determined by 
     the Secretary, any other expenditure.''.
       (2) Conforming amendment.--Section 2729 of the Public 
     Health Service Act (42 U.S.C. 300gg-29) is amended by adding 
     at the end the following new subsection:
       ``(c) Sunset.--The preceding provisions of this section 
     shall not apply beginning on the date of the enactment of 
     this subsection.''.
       (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.), as amended by section 106, 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 or 
     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 group 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 such 
     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 group 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.''.
       (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.), as amended by section 106, is further 
     amended by inserting after the item relating to section 726 
     the following new item:

``Sec. 727. Information on prescription drugs.''.
       (c) IRC.--
       (1) In general.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986, as amended by section 106, is 
     further amended by adding at the end the following:

     ``SEC. 9827. INFORMATION ON PRESCRIPTION DRUGS.

       ``(a) In General.--A group health plan shall--
       ``(1) not restrict, directly or indirectly, any pharmacy 
     that dispenses a prescription drug to a participant or 
     beneficiary in the plan 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 with respect to acquisition of 
     the drug and the amount an individual would pay for 
     acquisition of the drug without using any group health plan 
     or health insurance coverage; and
       ``(2) ensure that any entity that provides pharmacy 
     benefits management services under a contract with any such 
     plan 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 with respect to acquisition of 
     the drug and the amount an individual would pay for 
     acquisition of the drug without using any group 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, including any cost-sharing (including any 
     deductible, copayment, or coinsurance) and, as determined by 
     the Secretary, any other expenditure.''.
       (2) Clerical amendment.--The table of sections for 
     subchapter B of chapter 100 of the Internal Revenue Code of 
     1986, as amended by section 106, is further amended by adding 
     at the end the following new item:

``Sec. 9827. Information on prescription drugs.''.

     SEC. 404. IMPLEMENTATION FUNDING.

       (a) In General.--For the purposes described in subsection 
     (b), and in addition to amounts otherwise available for such 
     purposes there are appropriated, out of amounts in the 
     Treasury not otherwise appropriated, to the Secretary of 
     Labor $35,000,000, for fiscal year 2024, to remain available 
     through fiscal year 2029.
       (b) Permitted Purposes.--The purposes described in this 
     subsection are limited to the following purposes, insofar as 
     such purposes are to carry out the provisions of, including 
     the amendments made by, title I and IV:
       (1) Preparing, drafting, and issuing proposed and final 
     regulations or interim regulations.
       (2) Preparing, drafting, and issuing guidance and public 
     information.
       (3) Preparing, drafting, and publishing reports.
       (4) Enforcement of such provisions.
       (5) Reporting, collection, and analysis of data.
       (6) Other administrative duties necessary for 
     implementation of such provisions.
       (c) Transparency of Implementation Funds.--The Secretary of 
     Labor shall annually submit, no later than September 1st of 
     each year, to the Committees on Education and Workforce and 
     on Appropriations of the House of Representatives and the 
     Committees on Health, Education, Labor, and Pensions and on 
     Appropriations of the Senate a report on funds expended 
     pursuant to funds appropriated under this section.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Washington (Mrs. Rodgers) and the gentleman from New Jersey (Mr. 
Pallone) each will control 20 minutes.
  The Chair recognizes the gentlewoman from Washington.


                             General Leave

  Mrs. RODGERS of Washington. Mr. Speaker, I ask unanimous consent that 
all Members may have 5 legislative days in which to revise and extend 
their remarks and include extraneous material in the Record on the 
bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Washington?
  There was no objection.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield myself such time as 
I may consume.
  I rise in support of the Lower Cost, More Transparency Act. We all 
know that healthcare is too expensive, and the system is far too 
complicated. In the Committee on Energy and Commerce, we have heard 
countless stories about real patients who were victims of an opaque 
system and were on the hook for staggering amounts of money for seeing 
a doctor, going to a hospital, or getting medicine.
  We heard about a patient who tried to shop for her care and was 
billed thousands of dollars more than what she was quoted. We heard 
about a patient who was overcharged $11,000 by a hospital for services 
she didn't receive. We heard moving testimony from cancer patient 
advocates about policies we can enact right now to lower their drug 
costs.
  The Lower Costs, More Transparency Act includes these and other 
policies that would directly help all these patients. It lowers costs 
for Americans through increased healthcare price transparency. It 
ensures that senior citizens on Medicare never pay more for a drug 
because of where it is administered, and it makes drug prices 
transparent to help patients and employers

[[Page H6786]]

get the best deals possible on medicines.
  Over 90 percent of Americans support increased price transparency in 
healthcare. By passing this bill, we will be delivering results people 
are counting on. Further, CBO confirms that the bill would save 
taxpayers more than $700 million over the next decade.
  I thank Chairman Jason Smith, Chairwoman Virginia Foxx, and Ranking 
Member Frank Pallone for their leadership. I thank Majority Leader   
Steve Scalise for working with us to bring this bill to the floor 
today.
  Also, a special thank you to Ranking Member Pallone's team, notably 
Tiffany Guarascio, Waverly Gordon, Una Lee, and Saha Khaterzai for 
working with us to find this bipartisan agreement.
  Finally, I thank my own staff, especially Grace Graham, Corey 
Ensslin, and Kristin Flukey for their tireless efforts that will make a 
meaningful difference for patients all across this Nation.
  In sum, this bill is a legislative opportunity, bipartisan, regular 
order, and fully paid for. It advances foundational healthcare reforms 
for patients, lowers healthcare costs, and reduces the deficit.
  Mr. Speaker, I urge all my colleagues to support the Lower Costs, 
More Transparency Act, and I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of H.R. 5378, the Lower Costs, 
More Transparency Act. This bipartisan bill does exactly what it says 
it does: It delivers lower healthcare costs for the American people and 
brings much-needed transparency to our Nation's healthcare system.
  Access to affordable healthcare remains a major challenge for many 
American families. More than 40 percent of adults say they have either 
delayed or forgone medical care because of high costs. Prices for 
healthcare services also vary widely. Consumers often have difficulty 
obtaining price information to begin with. Another problem is that the 
information can be misleading or inaccurate, making it difficult for 
consumers to compare prices across healthcare providers before 
receiving care. Too many patients are forced to wait until after they 
receive care and receive their medical bill to see what they actually 
owe.
  H.R. 5378 brings some much-needed transparency to the healthcare 
system by codifying and strengthening important price transparency 
protections. It is a victory for everyone who has ever struggled to 
navigate and understand the cost of a healthcare procedure or a 
prescription drug at the pharmacy counter. These measures will empower 
consumers and employers with data on the prices hospitals charge and 
the rates insurers pay so that they can compare prices and save money.
  It also increases transparency of how pharmacy benefit managers, or 
PBMs, affect drug prices at the pharmacy counter. This will also help 
increase competition and lower healthcare costs for Americans. We have 
added new language in the bill to enhance the privacy protections for 
consumers' health information and to ensure that the full protection of 
the HIPAA privacy rule is applicable.
  I also want to mention, Mr. Speaker, the bill reduces costs for 
patients by ensuring Medicare beneficiaries are not paying more for the 
exact same drug because it was administered in a hospital outpatient 
department instead of a physician's office. It will also build on 
Democrats' work to rein in the soaring cost of prescription drugs by 
requiring the FDA to provide more information to generic drug 
manufacturers during the development process. This will help speed up 
the path to market and increase competition sooner to lower drug prices 
faster. All of these provisions in this bill will help make healthcare 
and prescription drugs more affordable for the American people.
  I also want to mention, Mr. Speaker, that H.R. 5378 will also make 
healthcare more accessible to American families thanks to critical 
investments in our Nation's public health programs that serve low-
income and uninsured patients. The bill includes increased funding for 
community health centers at $4.4 billion per year, an unprecedented 10 
percent increase over current funding levels.

  Community health centers are a critical source of primary healthcare 
for more than 30 million patients, 1 in every 11 Americans. These 
centers deliver high-quality, affordable healthcare to some of our most 
vulnerable communities, and this increased funding will allow these 
centers to continue providing this critical care.
  The bill increases funding for the National Health Service Corps, 
which places doctors in high-need communities. It also includes an 
unprecedented 7 years of funding, more than double the funding under 
current law, for the Teaching Health Center Graduate Medical Education 
program to support the training of primary care physicians in 
community-based settings. This program helps address doctor shortages 
in underserved areas as graduates of the program are likely to practice 
close to their training sites and to care for underserved patients. 
This long-term funding will help bring more certainty to the program to 
ensure that teaching health centers can plan and recruit for their 
residency programs.
  Finally, the bill also reauthorizes and increases funding for both 
the Special Diabetes Program and Special Diabetes Program for Indians. 
These programs provide critical investments in diabetes research and 
care.
  I will also mention that H.R. 5378 eliminates looming cuts to 
Medicaid Disproportionate Share Hospitals to support these high-need 
hospitals that provide care for large numbers of Medicaid and uninsured 
patients.
  The increased funding for each of these public health and workforce 
programs is essential to ensuring access to care for our constituents 
across the country. All of this funding is fully offset with policies 
that will further strengthen our healthcare system and help reduce 
costs for American families.
  Mr. Speaker, when a version of this bill came before the Committee on 
Energy and Commerce, it passed unanimously with bipartisan support. 
Chair Rodgers and I have been working on this bill all year, and I 
commend her for her ongoing commitment to get it across the finish 
line. It is an important bill that delivers meaningful results.
  I will also take an opportunity to thank some of the staff who have 
worked on this. From my committee staff, I thank Tiffany Guarascio, 
Waverly Gordon, Una Lee, Saha Khaterzai, Rick Van Buren, Stephen 
Holland, and Lydia Abma. From the Republican staff, I thank Nate 
Hodson, Sarah Burke, Grace Graham, and Corey Ensslin.
  Floor action today simply would not have been possible without months 
of long-term commitment by the staff on both sides of the aisle to get 
this done. I think you can tell that I really think this is probably 
one of the most important bills that will come out of the Committee on 
Energy and Commerce this session. It is truly bipartisan, which is 
another thing I think is very important right now.
  I strongly urge my colleagues to join me in supporting the bill to 
lower healthcare costs for the American people and to make healthcare 
more accessible.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Speaker, I would like to engage in a 
colloquy with Ranking Member Pallone.
  This bill codifies and strengthens healthcare price transparency 
requirements. Congress asserting itself to declare price transparency 
the law of the land is critical, but Congress can't account for every 
specificity and eventuality that is needed to ensure price transparency 
policies established by the Trump and Biden administrations are set in 
stone. We have to allow implementing agencies discretion to update 
regulations that reflect changes in terminology and technology over 
time.
  For example, with respect to health insurance price transparency, it 
is the intent of this House that this law shall be implemented to 
ensure that health plans report the prices that they have negotiated 
with the hospitals, other providers, and drug manufacturers to allow 
patients and employers purchasing coverage to use these data to drive 
down healthcare prices through open competition.
  Under existing regulations, health plans and insurers must disclose 
very specific price information for all

[[Page H6787]]

healthcare items and services. This bill codifies the authority holding 
up those regulations to ensure that such robust data continues to be 
disclosed. These data include all billing codes and modifiers, using 
industry-standard, government-recognized, commonly used code sets used 
by all medical providers to define specific healthcare items and 
services. We ensure the data are accurate by requiring providers' ID 
codes, place of service codes, and health plan identifiers assigned to 
the group health plan and insurer, all critical information that makes 
price disclosures comparable across different health plans.
  It is our intent that the requirements for transparency in coverage 
should be as comprehensive as possible, without limitations. I yield to 
the gentleman from New Jersey (Mr. Pallone), the ranking member for the 
purpose of a colloquy.

  Mr. PALLONE. Mr. Speaker, let me say that I concur with my colleagues 
and partners in crafting this important bipartisan piece of legislation 
that is intended to codify and improve upon the robust requirements 
that exist in the regulations that have been implemented by both the 
Trump and Biden administrations. With this bill, we seek to bring true 
health price transparency to lower costs for patients, employers, and 
unions purchasing health coverage.
  This bill is a floor, not a ceiling, and I intend that the 
implementing agencies will use the discretion left to them to ensure 
that health plans and insurers disclose the detailed price information 
and necessary data on reimbursement rates for healthcare items and 
services. We intend to follow this colloquy with a bipartisan letter to 
the agencies reiterating our expectations in greater detail.
  In addition, in further colloquy with Chair Rodgers, I address a 
technical change that needs to be made to the bill in negotiations with 
the Senate. In the new version of the bill, we have limited the drug 
price data flowing to small employers in order to strengthen health 
privacy protections for their employees. However, I want to make clear 
that we did not intend to exclude multiemployer, public sector, or 
retiree-only and union health plans under this new provision, and we 
are committed to fixing this issue before the bill becomes law. Ranking 
Member  Bobby Scott also agrees with this perspective.
  I ask Chair Rodgers if she would concur with me that we make sure 
this issue is addressed in our negotiation with the Senate and before 
the bill becomes law.
  Mrs. RODGERS of Washington. Mr. Speaker, I thank Ranking Member 
Pallone for his ongoing leadership, and I agree it is critical that the 
legislation meets our intent when it comes to ensuring that the PBMs 
must be transparent with multiemployer, public sector, and retiree-only 
health plans along with all other employer health plans. I do concur 
that we will address this issue in negotiations with the Senate, and I 
look forward to working to make sure this bill becomes law.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Doggett), a member of the Ways and Means Committee.

                              {time}  1615

  Mr. DOGGETT. Mr. Speaker, this transparency bill lacks transparency 
on two of the major problems that are impacting soaring healthcare 
costs. The only reason to reject transparency for, first, private 
equity and, second, Medicare Advantage is that they have got more to 
hide and apparently more lobbying power.
  A growing private equity takeover of healthcare has already 
undermined care in nursing homes and now threatens hospitals and 
medical specialty practices across the United States with higher 
prices, higher cost to taxpayers, and less quality.
  A Senate committee has just launched a major investigation into the 
impact of private equity on hospital costs and lower quality care.
  Having failed to save taxpayers a dime that was promised--of the many 
millions that was promised--Medicare Advantage costs $1,500 per person 
each year over the cost of traditional Medicare. That is billions in 
wasted taxpayer dollars.
  The best way to fund much-needed services at community health centers 
and to expand and improve and strengthen Medicare with services such as 
dental, hearing, and vision is to take it right out of Medicare 
Advantage.
  This bill, I believe, should be rejected until these issues are 
addressed by permitting the very amendments that we offered in the 
House Ways and Means Committee that rejected them, as usual, to address 
private equity and Medicare Advantage.
  Mr. Speaker, with all respect to the bipartisan efforts and hard work 
in the Energy and Commerce Committee, I believe there is a better way 
to finance needs, and a very important need, to address the issues of 
transparency on Medicare Advantage and private equity. Therefore, I 
oppose the bill.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 2 minutes to the 
gentlewoman from North Carolina (Ms. Foxx), the chairwoman of the 
Education and the Workforce Committee. I appreciate her partnership on 
this legislation.
  Ms. FOXX. Mr. Speaker, the American healthcare system is a complex, 
expensive maze fueled by heavyhanded regulation, consolidation, and 
lack of transparency. Growth in health spending is rising at 
unsustainable rates, forcing insurance premiums and out-of-pocket costs 
higher and remaining too expensive for working families.
  The bill before us is a bipartisan solution to help lower costs by 
pulling the curtain back on healthcare and revealing anticompetitive 
industry practices that are stifling the free market.
  Included in this bill is the Hidden Fee Disclosure Act, authored by 
Representatives   Joe Courtney and Erin Houchin, which requires 
pharmacy benefit managers, PBMs, and third-party administrators to 
disclose hidden compensation to plan sponsors.
  The Health DATA Act, authored by Representative Lori Chavez-DeRemer, 
is also included in this legislation. It prohibits gag clauses between 
health plans and third-party entities, which restricts a plan sponsor's 
access to its own data.
  Additionally, the bill includes the Transparency in Coverage Act, 
authored by Representative  Bob Good. It builds on the general 
principles of transparency and accountability enshrined in the No 
Surprises Act by requiring health plans to disclose their prices 
publicly.
  Patients have been left in the dark. Because of opaque rules and 
industry practices, patients are often left paying higher costs. This 
is why we are taking action and shining a light on these issues. 
Increasing transparency has been proven to root out waste successfully 
and save healthcare dollars.
  Bottom line, we want to provide workers and their families with more 
options at lower prices. The Lower Costs, More Transparency Act does 
just that while also reducing the deficit by $800 million.
  Mr. Speaker, I encourage my colleagues to support its passage.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I thank my friend, Representative Doggett, for his hard 
work on the important issues that he raised and that have been raised 
today. I should mention that he is the ranking member of the Ways and 
Means Health Subcommittee, so he is very familiar with these issues.
  I know he thinks that certain things should have been added to this 
bill, but I want to stress that I think we have to support this bill 
based on the important policies that we have in the bill. It is not 
always easy to get consensus between Democrats and Republicans. This is 
one of those rare examples, unfortunately, where we have come to a 
consensus, which our committee often does. That is why I do stress the 
important policies that are in it.
  I think the legislation is a victory for the American people. It 
addresses a lot of obvious failings in our health system. The bill 
brings some much-needed price transparency to the healthcare system and 
will help lower healthcare costs for patients.
  Americans have been struggling for years to obtain accurate price 
information before going in for a healthcare procedure. It is difficult 
for patients to know how much a hospital or their insurance company 
will charge them for the care that they receive.

[[Page H6788]]

  All this information should be readily available to the public. This 
bill requires hospitals and insurance companies to list prices in an 
easy to understand format for patients.

  The bill also prevents hospital outpatient facilities from unfairly 
overcharging seniors. This policy will save Medicare beneficiaries $1.4 
billion in lower premiums.
  The bill helps further rein in the cost of prescription drugs by 
cracking down on price gouging by pharmacy benefit managers and 
requires the PBMs to be transparent about their price information.
  This is going to help lower healthcare costs for both employers and 
patients and bring needed oversight to the PBM industry.
  In addition to these patient protection provisions, the legislation 
includes a historic $15 billion in investments in safety net and 
workforce programs and programs to address physician shortages around 
the country.
  The legislation essentially lowers healthcare costs for the American 
people and makes healthcare more accessible to American families. I 
think this delivers meaningful results to the American people on a 
bipartisan basis.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 2 minutes to the 
gentleman from Kentucky (Mr. Guthrie), the chairman of the Health 
Subcommittee.
  Mr. GUTHRIE. Mr. Speaker, I rise today to speak in support of H.R. 
5378, the Lower Costs, More Transparency Act.
  Over the past several years, I have heard from countless Kentuckians 
about the challenges they face and the pain they are feeling due to 
rising healthcare costs. This bipartisan, landmark legislation marks 
the first step in driving transformational change across our healthcare 
system.
  The Lower Costs, More Transparency Act incorporates transparency 
requirements in nearly every aspect of the healthcare system. We are 
building on the Trump-era price transparency rules for hospitals and 
insurance plans. We are requiring pharmacy benefit managers to disclose 
prices and fees to lower costs for patients and employers. We are even 
requiring transparency for clinical labs.
  We have countless testimonials and data to show that transparency 
lowers costs. Recently, a multinational equipment manufacturer fired 
their PBM and started managing their own prescription drug benefits for 
its employees because they finally understood what they were being 
charged.
  The most important part about this bill is that, for once, it is not 
a top-down, Washington-knows-best approach to the cost of healthcare.
  The American people have given Congress this mandate, with over 95 
percent of surveyed voters supporting healthcare price transparency to 
reduce healthcare costs, according to a 2022 KFF poll.
  The Lower Costs, More Transparency Act directly lowers costs that 
seniors are paying out of pocket for certain drugs like cancer drugs 
and other medicines administered in doctors' offices that are owned by 
hospitals.
  Seniors receiving Medicare should not be paying more for a drug based 
solely off the location of where they receive the drug. We are fixing 
this.
  I should note that we are able to get major policy changes in this 
legislation while making sure the bill saves the American people money, 
an estimated $700 million. This is an objective that Congress very 
rarely prioritizes.
  Mr. Speaker, I thank Chair Rodgers for her vision and steadfast 
leadership on this bill. I will proudly be casting a ``yes'' vote on 
H.R. 5378, and I urge my House colleagues to do the same.
  Mr. PALLONE. Mr. Speaker, I have no additional speakers. If the chair 
needs time for people who will support the bill, I will yield to them.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 2 minutes to the 
gentleman from Missouri (Mr. Smith), the chairman of the House Ways and 
Means Committee.
  Mr. SMITH of Missouri. Mr. Speaker, the Lower Costs, More 
Transparency Act empowers patients and will lower healthcare costs for 
millions of Americans.
  This bipartisan bill has been a collaborative effort, and I thank my 
colleagues on the Energy and Commerce Committee and the Education and 
the Workforce Committee for their partnership.
  American families have struggled for far too long to afford the cost 
of their healthcare. What is worse is they have been unable to 
anticipate those costs because our current system makes it nearly 
impossible to figure out the actual price for almost any type of 
treatment, medicine, drug, or procedure.
  The legislation before us would ensure timely and accurate details 
about the cost of care, treatments, and services are available and 
accessible before a patient goes into the doctor's office or hospital.
  Hospitals, insurance companies, labs, imaging providers, and others 
would be required to publicly disclose their prices, creating 
incentives to lower prices across the board. This bill would increase 
access to care by combating healthcare consolidation, which reduces 
options and drives up costs.
  It also would take an important step to address the soaring costs of 
prescription drugs by requiring health insurers and PBM middlemen to 
disclose negotiated drug rebates and discounts. It would ease the 
financial burden on our seniors, widen access to more affordable 
generic drugs, and arm employers with vital drug price information.
  This bill would make important investments in training programs for 
new doctors to help address the healthcare workforce shortage and 
further invest in hospitals that serve high Medicaid populations.
  Mr. Speaker, I urge my colleagues to support this bill to deliver a 
healthcare system that is more accessible and affordable for the 
American people.
  Mr. PALLONE. Mr. Speaker, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 1 minute to the 
gentleman from Florida (Mr. Bilirakis), a subcommittee chair.

  Mr. BILIRAKIS. Mr. Speaker, I rise in strong support of H.R. 5378, 
the Lower Costs, More Transparency Act.
  I hear from my constituents on a regular basis that the cost of 
healthcare is too high, and it remains a burden for everyday Americans 
who are struggling to get by.
  This bipartisan package led by Chair Rodgers, who I appreciate so 
much, finally looks to turn the tide of these high costs by injecting 
much-needed transparency and accountability into our healthcare system. 
This includes updating CMS' price transparency rules so they actually 
work effectively for patients. It ensures we better understand and 
reduce consolidation among hospitals, insurers, and PBMs alike.
  This also includes my bill with Representative DeGette to reauthorize 
the Special Diabetes Program for 2 years with increased funding, all 
while reducing the deficit by $750 million.
  Mr. Speaker, I urge my colleagues to support this transformative 
package.
  Mr. PALLONE. Mr. Speaker, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 2 minutes to the 
gentleman from Indiana (Mr. Bucshon), the vice chair of the Health 
Subcommittee.
  Mr. BUCSHON. Mr. Speaker, I rise today in strong support of H.R. 
5378, the Lower Costs, More Transparency Act.
  This bill, which was a product of thorough bipartisan work across 
three committees, is one of the strongest healthcare bills I can 
remember voting on since coming to Congress in 2011. Honestly, it 
really is. I want to say that again: It is one of the strongest 
healthcare bills I can remember voting on since coming to Congress.
  I thank Chair Rodgers, Ranking Member Pallone, and the members of the 
other two committees for their hard work on getting this bill to the 
floor.
  At nearly $13,000 per person, or about 18 percent of the GDP, U.S. 
national health expenditures far exceed other high-income countries, 
and they continue to rise at unsustainable rates.
  Congress must enact serious reforms that spur competition and show 
taxpayers where all of these healthcare dollars are going. They are 
certainly not always going to them.

                              {time}  1630

  The problem is not limited to one part of our healthcare system, and 
so

[[Page H6789]]

the solution must also reach across the entire system. This legislation 
seeks to increase transparency and lower costs related to hospital 
care, outpatient services, and prescription drugs, among other things. 
It also reauthorizes community health centers and supports 
disproportionate share hospitals.
  Finally, we cannot get control of our national debt and deficit 
unless we first have transparency in our healthcare system, one of the 
largest expenditures that the Federal Government has. This bill is a 
tremendous step in that direction.
  Mr. Speaker, I am proud to support this legislation, and I urge all 
my colleagues to support it.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 1 minute to the 
gentleman from Georgia (Mr. Carter).
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentlewoman for 
yielding.
  Mr. Speaker, I rise today in strong support of H.R. 5378, the Lower 
Costs, More Transparency Act.
  As a pharmacist for over four decades, I have seen firsthand how our 
healthcare system treats patients with unaffordable prices and 
inaccessible care.
  Under the leadership of Chairwoman Rodgers and Health Subcommittee 
Chairman Guthrie, we can do something about it by reining in the PBMs 
and putting patients before profits.
  Included in this bill is my Drug Price Transparency in Medicaid Act 
which puts an end to the PBM games by prohibiting spread pricing in 
Medicaid and increasing transparency and fairness to community 
pharmacies by allowing them to be reimbursed at an appropriate rate for 
dispensing medications to Medicaid patients.
  I am also pleased to see my PBM Accountability Act is also included 
in this bill.
  The Lower Costs, More Transparency Act is such an important first 
step towards bringing down prescription drug prices by addressing the 
root cause: the middlemen who prey on patients for profits.
  Mr. Speaker, I urge my colleagues to support the Lower Costs, More 
Transparency Act.
  Mrs. RODGERS of Washington. Mr. Speaker, I yield 1 minute to the 
gentleman from Pennsylvania (Mr. Joyce).
  Mr. JOYCE of Pennsylvania. Mr. Speaker, I thank the gentlewoman for 
yielding.
  The Lower Costs, More Transparency Act is part of our commitment to 
supporting our patients, creating access to affordable medications, and 
making the healthcare process easier to access for literally all 
Americans.
  Included in this legislation is my bill, the Strengthening Community 
Care Act, which would reauthorize support for community health centers. 
These centers are a vital source of care for over 30 million Americans 
and nearly 240,000 individuals in Pennsylvania's 13th Congressional 
District.
  By reducing barriers like cost, lack of insurance, or distance, 
community health centers are able to provide high-quality treatment to 
the patients who need it the most: the patients who are underinsured or 
not insured at all.
  Mr. Speaker, I urge all of my colleagues to support the Lower Costs, 
More Transparency Act, and I will be voting ``yes'' for this important 
piece of legislation.
  Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I cannot emphasize the importance of this bill. I think 
that in terms of the overall effort to increase affordability, to 
increase access to healthcare, and to make sure that there is 
competition, if you will, within the hospital industry and within the 
insurance industry, this bill does all of those things.
  It is really amazing, in my opinion, that we are able to do this on a 
bipartisan basis. It came out of committee, I believe, unanimously. I 
think it will go far towards increasing affordability, accessibility, 
and competition, which also lowers prices.
  For all those reasons, Mr. Speaker, I urge support for the 
legislation, and I yield back the balance of my time.
  Mrs. RODGERS of Washington. Mr. Speaker, I, too, want to urge support 
for this major bipartisan legislation. It is very important healthcare 
legislation. We are concerned about consolidation within healthcare and 
the rising costs within healthcare.
  The first way we are going to address that is by demanding 
transparency. We have to know what the prices actually are so that we 
can empower patients and we can get some more competition within our 
healthcare system.
  I thank everyone who has worked together. This was a priority we laid 
out at the very beginning of this Congress. It has been months' worth 
of work.
  A big thank you, again, to the ranking member of the Energy and 
Commerce Committee, as well as the other committees, the chairmanship 
of Virginia Foxx and the chairman of the Ways and Means Committee, 
Jason Smith, for working together. We have all contributed, and we have 
a better product because of it.
  I definitely urge support by my colleagues both Republicans and 
Democrats. This is one that we need to get on the President's desk with 
a big vote today.
  Mr. Speaker, I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Speaker, one of the reasons health care 
costs are so high is that consumers and employers often do not have 
enough information about what they are paying for.
  This makes it hard for patients to find affordable, high-quality 
health care providers. And it prevents employers from spending workers' 
premium dollars carefully. It also hinders competition, which keeps 
health care costs in check. And finally, it limits our ability as 
policymakers to improve the health care system.
  Americans deserve to know what they are being asked to pay. The Lower 
Costs, More Transparency Act helps ensure health care costs are driven 
by those who provide the highest quality services, not those with the 
most market power.
  This bill includes several bipartisan priorities for our Committee 
Members, and I thank my colleagues on both sides of the aisle for 
working together on this package.
  I am especially pleased that it strengthens oversight of the direct 
and indirect compensation earned by health plan service providers. This 
includes not only pharmacy benefit managers but also--critically--
insurance companies serving as third-party administrators for self-
funded plans.
  I was also pleased to work with my colleagues to ensure strong 
privacy protections for workers.
  Finally, I appreciate my colleagues' bipartisan commitment to 
incorporating technical corrections to ensure that the reporting 
requirements for pharmacy benefit managers apply fully to multiemployer 
plans, state and local government plans, and retiree-only plans--
consistent with the intent of the legislation.
  Moving forward, we must continue to promote transparency and 
competition and take direct action to lower health care costs for 
workers and their families.
  Ms. FOXX. Mr. Speaker, the goal of the Lower Costs, More Transparency 
Act is to allow a wide range of employers, workers, and health plans to 
benefit from increased transparency of pharmacy benefit managers so 
they can make more informed, cost-conscious health care decisions.
  It has come to our attention that the definition of large employer in 
this bill, as written, may have inadvertently left out certain types of 
non-employer plans, such as multiemployer, union, governmental, and 
retiree plans.
  I rise today to affirm that my colleagues and I never intended for 
this bill to exclude these plans from leveraging the transparency tools 
included in this bill.
  We remain committed to addressing this technical issue as we work 
with our Senate colleagues to expand transparency in health care 
following passage of the Lower Costs, More Transparency Act today.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Washington (Mrs. Rodgers) that the House suspend the 
rules and pass the bill, H.R. 5378, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mrs. RODGERS of Washington. Mr. Speaker, on that I demand the yeas 
and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

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