[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2816 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 2816
To amend title XI of the Social Security Act to strengthen transparency
requirements with respect to pharmacy benefit managers.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 25, 2023
Mrs. Harshbarger (for herself, Ms. Spanberger, Mrs. Miller-Meeks, and
Mr. Krishnamoorthi) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committee on Ways and Means, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to strengthen transparency
requirements with respect to pharmacy benefit managers.
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 ``Pharmacy Benefit Manager Sunshine
and Accountability Act''.
SEC. 2. STRENGTHENING PHARMACY BENEFIT MANAGER TRANSPARENCY
REQUIREMENTS.
Section 1150A of the Social Security Act (42 U.S.C. 1320b-23) is
amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``; or'' and
inserting a semicolon;
(B) in paragraph (2), by striking the comma at the
end and inserting ``; or''; and
(C) by adding at the end the following new
paragraph:
``(3) a group health plan or health insurance issuer
offering group or individual health insurance coverage (as such
terms are defined in section 2791 of the Public Health Service
Act),'';
(2) by amending subsection (b) to read as follows:
``(b) Information Described.--The information described in this
subsection is the following with respect to services provided by a
health benefits plan or PBM for a contract year:
``(1) With respect to a contract with each entity described
in paragraphs (1) through (3) of subsection (a), the aggregate
dollar amount of all--
``(A) rebates that a PBM or health benefits plan
received under each such contract from all drug
manufacturers;
``(B) administrative fees that a PBM or health
benefits plan received under each such contract with
from all drug manufacturers;
``(C) administrative fees that a PBM or health
benefits plan received under each contract from each
such entity;
``(D) rebates that a PBM or health benefits plan
received under each contract with each entity from all
pharmaceutical manufacturers that were not passed
through to such entities;
``(E) administrative fees that a PBM or health
benefits plan received under each contract from all
pharmaceutical manufacturers and did not pass through
to such entities;
``(F) total post-claim adjudication payments that a
PBM or health benefits plan collected from a pharmacy
under each contract, including any fees,
reimbursements, or other claw backs including generic
effective rate and brand effective rate contracts; and
``(G) any post-claim adjudication payments that a
PBM or health benefits plan collected from a pharmacy
under each contract, including any fees,
reimbursements, or other claw backs including generic
effective rate and brand effective rate contracts that
were not passed through to such entities.
``(2) The aggregate retained rebate percentage under each
contract (that is the value in paragraph (1)(D) divided by the
value in paragraph (1)(A)).
``(3) Across all contractual relationships for each PBM
whereby such PBM is managing prescription drug coverage for a
entity described in in paragraphs (1) through (3) of subsection
(a), the highest retained rebate percentage and lowest retained
rebate percentage for each contract under which such PBM
provided services.'';
(3) in subsection (c)--
(A) in the matter preceding paragraph (1), by
striking ``, plan, or prices charged for drugs,'' and
inserting ``or plan, the prices charged for a specific
drug or classes of drugs, or the amount of any rebates
provided for a specific drug or classes of drugs,'';
and
(B) by adding at the end the following new
paragraph:
``(5) To carry out the reporting requirement under
subsection (e).''; and
(4) by adding at the end the following new subsections:
``(e) Public Reporting Requirement.--Not later than the first
calendar quarter following the first full plan year beginning on or
after the date of enactment of this subsection, and annually
thereafter, the Secretary shall publish on a public website of the
Department of Health and Human Services the information reported under
subsection (b), in accordance with the confidentiality requirements
described in subsection (c).
``(f) Definitions.--In this section:
``(1) Brand effective rate.--The term `brand effective
rate' means the claim reimbursement for a brand name drug,
expressed as a percentage discount from the average wholesale
price of such drug.
``(2) Generic effective rate.--The term `generic effective
rate' means the claim reimbursement for a generic drug,
expressed as a percentage discount from the average wholesale
price of such drug.
``(3) Pharmacy benefits manager.--The term `pharmacy
benefits manager' or `PBM' means--
``(A) an entity that manages prescription drug
benefits on behalf of an entity described in paragraphs
(1) through (3) of subsection (a); and
``(B) for purposes of this section, includes any
other organization that--
``(i) has directly or indirectly (as
determined by the Secretary in regulations), an
ownership interest of 5 percent or more in the
PBM;
``(ii) shares, or is otherwise a part of,
the same organizational structure as the PBM;
``(iii) exercises operational, financial,
or managerial control over the PBM or a part
thereof, or provides policies or procedures for
any of the operations of the PBM, or provides
financial or cash management services to the
PBM; or
``(iv) provides management or
administrative services, management or clinical
consulting services, or accounting or financial
services to the PBM.
``(4) Organizational structure.--The term `organizational
structure' means, in the case of--
``(A) a corporation, the officers, directors, and
shareholders of the corporation who have an ownership
interest in the corporation which is equal to or
exceeds 5 percent;
``(B) a limited liability company, the members and
managers of the limited liability company;
``(C) a general partnership, the partners of the
general partnership;
``(D) a limited partnership, the general partners
and any limited partners of the limited partnership who
have an ownership interest in the limited partnership
which is equal to or exceeds 5 percent;
``(E) a trust, the trustees of the trust; or
``(F) any other person or entity as the Secretary
determines appropriate.''.
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