Creating Transparency to Have Drug Rebates Unlocked (C–THRU) Act of 2019

II 116TH CONGRESS 1ST SESSION S. 476 To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. IN THE SENATE OF THE UNITED STATES FEBRUARY 13, 2019 Mr. WYDEN (for himself, Mr. BROWN, Mr. CARPER, and Mr. TESTER) intro- duced the following bill; which was read twice and referred to the Com- mittee on Finance A BILL To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Creating Transparency 4 to Have Drug Rebates Unlocked (C–THRU) Act of 5 2019’’. 6 SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS. 7 (a) IN GENERAL.—Section 1150A of the Social Secu- 8 rity Act (42 U.S.C. 1320b–23) is amended— 9 VerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S476.IS S476 pbinns on DSK79D2C42PROD with BILLS 2 •S 476 IS (1) in subsection (c), in the matter preceding 1 paragraph (1), by striking ‘‘this section’’ and insert- 2 ing ‘‘subsection (b)(1)’’; and 3 (2) by adding at the end the following new sub- 4 section: 5 ‘‘(e) PUBLIC AVAILABILITY OF CERTAIN INFORMA- 6 TION.—In order to allow patients and employers to com- 7 pare PBMs’ ability to negotiate rebates, discounts, and 8 price concessions and the amount of such rebates, dis- 9 counts, and price concessions that are passed through to 10 plan sponsors, beginning January 1, 2020, the Secretary 11 shall make available on the Internet website of the Depart- 12 ment of Health and Human Services the information pro- 13 vided to the Secretary under paragraphs (2) and (3) of 14 subsection (b) with respect to each PBM. The Secretary 15 shall ensure that such information is displayed in a man- 16 ner that prevents the disclosure of information on rebates, 17 discounts, and price concessions with respect to an indi- 18 vidual drug or an individual plan.’’. 19 (b) EFFECTIVE DATE.—The amendments made by 20 subsection (a) shall take effect on January 1, 2020. 21 VerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S476.IS S476 pbinns on DSK79D2C42PROD with BILLS 3 •S 476 IS SEC. 3. MINIMUM DRUG DISCOUNTS REQUIRED TO BE 1 PASSED THROUGH TO THE PLAN SPONSOR. 2 (a) IN GENERAL.—Section 1150A of the Social Secu- 3 rity Act (42 U.S.C. 1320b–23), as amended by section 4 2(a)(2), is amended— 5 (1) in the heading, by inserting ‘‘; MINIMUM 6 DRUG DISCOUNTS REQUIRED TO BE PASSED 7 THROUGH TO THE PLAN SPONSOR’’ before the 8 period at the end; and 9 (2) by adding at the end the following new sub- 10 section: 11 ‘‘(f) MINIMUM DRUG DISCOUNTS REQUIRED TO BE 12 PASSED THROUGH TO THE PLAN SPONSOR.— 13 ‘‘(1) REQUIREMENT.—Beginning January 1, 14 2022, a PBM that manages prescription drug cov- 15 erage under a contract with a PDP sponsor or MA 16 organization described in subsection (b)(1) or a 17 qualified health benefits plan described in subsection 18 (b)(2), shall, with respect to the plan sponsor of a 19 health benefits plan, pass through to the plan spon- 20 sor a minimum percent (as established by the Sec- 21 retary) of the aggregate amount of the rebates, dis- 22 counts, or price concessions that the PBM nego- 23 tiates that are attributable to patient utilization 24 under the plan. 25 VerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S476.IS S476 pbinns on DSK79D2C42PROD with BILLS 4 •S 476 IS ‘‘(2) ESTABLISHMENT.—The Secretary shall es- 1 tablish the minimum percent described in paragraph 2 (1) in such a manner as will ensure that patients re- 3 ceive the maximum benefit of rebates, discounts, or 4 price concessions while taking into account the costs 5 of negotiating such rebates, discounts, and price 6 concessions. 7 ‘‘(3) ENFORCEMENT.—A PDP sponsor of a 8 prescription drug plan or an MA organization offer- 9 ing an MA–PD plan under part D of title XVIII 10 may not contract with a PBM that is not in compli- 11 ance with the requirement under paragraph (1).’’. 12 (b) EFFECTIVE DATE.—The amendments made by 13 subsection (a) shall take effect on January 1, 2022. 14 SEC. 4. PART D NEGOTIATED PRICES REQUIRED TO TAKE 15 INTO ACCOUNT ALL PRICE CONCESSIONS AT 16 THE POINT-OF-SALE. 17 (a) IN GENERAL.—Section 1860D–2(d)(1)(B) of the 18 Social Security Act (42 U.S.C. 1395w–102(d)(1)(B)) is 19 amended— 20 (1) by striking ‘‘PRICES.—For purposes’’ and 21 inserting ‘‘PRICES.— 22 ‘‘(i) IN GENERAL.—For purposes’’; 23 and 24 VerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S476.IS S476 pbinns on DSK79D2C42PROD with BILLS 5 •S 476 IS (2) by adding at the end the following new 1 clause: 2 ‘‘(ii) NEGOTIATED PRICES AT POINT- 3 OF-SALE.— 4 ‘‘(I) IN GENERAL.—Negotiated 5 prices for covered part D drugs de- 6 scribed in clause (i), including all 7 price negotiated concessions, shall be 8 provided at the point-of-sale of the 9 covered part D drug. If the negotiated 10 price, including all negotiated price 11 concessions, is not possible to cal- 12 culate at the point-of-sale, an approxi- 13 mate negotiated price (as established 14 by the Secretary) shall be used under 15 the prescription drug plan or MA–PD 16 plan. 17 ‘‘(II) APPROXIMATE NEGOTIATED 18 PRICE.—In determining an approxi- 19 mate negotiated price for a covered 20 part D drug under subclause (I), the 21 Secretary shall ensure that— 22 ‘‘(aa) such price reflects the 23 estimated negotiated price that is 24 based on the previous year’s ne- 25 VerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S476.IS S476 pbinns on DSK79D2C42PROD with BILLS 6 •S 476 IS gotiated price concessions nego- 1 tiated under the plan for all or 2 similar covered part D drugs or 3 is based on such other factors as 4 the Secretary may determine ap- 5 propriate; and 6 ‘‘(bb) the use of such price 7 does not prevent the use of value- 8 based contracts between drug 9 manufacturers, PDP sponsors, 10 MA organizations, and phar- 11 macies.’’. 12 (b) EFFECTIVE DATE.—The amendments made by 13 subsection (a) shall apply to plan years beginning on or 14 after January 1, 2021. 15 Æ VerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S476.IS S476 pbinns on DSK79D2C42PROD with BILLS