[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1374 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1374
To prohibit group health plans and health insurance issuers from
entering into contracts that would prevent or restrict patient access
to drug pricing information otherwise available through consumer
decision-support tools.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 27, 2023
Mr. Marshall (for himself, Mr. Markey, Mr. Grassley, and Mr. Kaine)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To prohibit group health plans and health insurance issuers from
entering into contracts that would prevent or restrict patient access
to drug pricing information otherwise available through consumer
decision-support tools.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Right to Shop Act''.
SEC. 2. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.
(a) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the
following:
``SEC. 2799A-11. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT
TOOLS.
``(a) In General.--A group health plan or a health insurance issuer
offering group or individual health insurance coverage shall not enter
into a contract with an entity that provides pharmacy benefit
management services with respect to such plan or coverage if such
contract--
``(1) includes any terms, conditions, or costs that would
prevent or restrict a third party who is in contract with the
plan or issuer to provide a consumer decision-support tool from
using relevant information regarding prescription drug benefits
under the plan or coverage that are administered by the entity
providing pharmacy benefit management services in contract with
the plan or issuer; or
``(2) fails to clearly state that the entity providing
pharmacy benefit management services is required to provide
data required under paragraph (1) in machine readable format
for the operability, implementation, and utilization of any
such consumer decision-support tool at no cost (direct or
indirect) to the group health plan, health insurance issuer, or
the third party providing such consumer decision support.
``(b) Consumer Decision-Support Tool.--In this section, the term
`consumer decision-support tool' means a tool designed to inform
enrollees in a group health plan or health insurance coverage about all
costs for prescription drugs covered by the plan or coverage, including
out-of-pocket, copayment, and coinsurance responsibility, as well as
additional savings opportunities through other channels such as
manufacturer copayment assistance, cash price, and mail order pharmacy
benefits.''.
(b) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following:
``SEC. 726. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage shall not enter into a
contract with an entity that provides pharmacy benefit management
services with respect to such plan or coverage if such contract--
``(1) includes any terms, conditions, or costs that would
prevent or restrict a third party who is in contract with the
plan or issuer to provide a consumer decision-support tool from
using relevant information regarding prescription drug benefits
under the plan or coverage that are administered by the entity
providing pharmacy benefit management services in contract with
the plan or issuer; or
``(2) fails to clearly state that the entity providing
pharmacy benefit management services is required to provide
data required under paragraph (1) in machine readable format
for the operability, implementation, and utilization of any
such consumer decision-support tool at no cost (direct or
indirect) to the group health plan, health insurance issuer, or
the third party providing such consumer decision support.
``(b) Consumer Decision-Support Tool.--In this section, the term
`consumer decision-support tool' means a tool designed to inform
participants and beneficiaries in a group health plan or health
insurance coverage about all costs for prescription drugs covered by
the plan or coverage, including out-of-pocket, copayment, and
coinsurance responsibility, as well as additional savings opportunities
through other channels such as manufacturer copayment assistance, cash
price, and mail order pharmacy benefits.''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting after the item
relating to section 725 the following:
``Sec. 726. Prohibition on blocking consumer decision-support tools.''.
(c) Internal Revenue Code.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at the end
the following new section:
``SEC. 9826. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.
``(a) In General.--A group health plan offering group health
insurance coverage shall not enter into a contract with an entity that
provides pharmacy benefit management services with respect to such plan
if such contract--
``(1) includes any terms, conditions, or costs that would
prevent or restrict a third party who is in contract with the
plan to provide a consumer decision-support tool from using
relevant information regarding prescription drug benefits under
the plan that are administered by the entity providing pharmacy
benefit management services in contract with the plan; or
``(2) fails to clearly state that the entity providing
pharmacy benefit management services is required to provide
data required under paragraph (1) in machine readable format
for the operability, implementation, and utilization of any
such consumer decision-support tool at no cost (direct or
indirect) to the group health plan or the third party providing
such consumer decision support.
``(b) Consumer Decision-Support Tool.--In this section, the term
`consumer decision-support tool' means a tool designed to inform
participants and beneficiaries in a group health plan about all costs
for prescription drugs covered by the plan, including out-of-pocket,
copayment, and coinsurance responsibility, as well as additional
savings opportunities through other channels such as manufacturer
copayment assistance, cash price, and mail order pharmacy benefits.''.
(2) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of such Code is amended by adding
at the end the following new item:
``Sec. 9826. Prohibition on blocking consumer decision-support
tools.''.
(d) Application.--The amendments made by subsections (a), (b), and
(c) shall apply with respect to plan years beginning on or after the
date that is 2 years after the date of enactment of this Act.
(e) Regulations.--The Secretary of Health and Human Services, the
Secretary of Labor, and the Secretary of the Treasury shall jointly
promulgate regulations to carry out the amendments made by subsections
(a), (b), and (c), and shall issue draft regulations not later than 1
year after the date of enactment of this Act.
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