Transparent Drug Pricing Act of 2019

II 116TH CONGRESS 1ST SESSION S. 977 To address the high cost of prescription drugs. IN THE SENATE OF THE UNITED STATES APRIL 1, 2019 Mr. SCOTT of Florida (for himself and Mr. HAWLEY) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To address the high cost of prescription drugs. 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 ‘‘Transparent Drug 4 Pricing Act of 2019’’. 5 SEC. 2. PRICE TRANSPARENCY AT PHARMACIES. 6 Section 1927(g)(2) of the Social Security Act (42 7 U.S.C. 1396r–8(g)(2)) is amended by adding at the end 8 the following new subparagraph: 9 ‘‘(E) DISCLOSURE OF DRUG PRICES AT 10 POINT OF SALE.—Beginning January 1, 2022, 11 VerDate Sep 11 2014 23:30 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S977.IS S977 kjohnson on DSK79L0C42 with BILLS 2 •S 977 IS as part of a State’s drug use review program, 1 applicable State law shall require pharmacists 2 to disclose to customers, at the point of sale of 3 any prescription drug— 4 ‘‘(i) the customer’s out-of-pocket cost 5 with respect to acquisition of such drug 6 under the health plan in which the cus- 7 tomer is enrolled, if applicable; and 8 ‘‘(ii) the cost to the consumer for ac- 9 quisition of the drug without using any 10 health plan.’’. 11 SEC. 3. REQUIREMENTS WITH RESPECT TO PRESCRIPTION 12 DRUG COST-SHARING. 13 Subpart II of part A of title XXVII of the Public 14 Health Service Act (42 U.S.C. 300gg–11 et seq.) is 15 amended by adding at the end the following: 16 ‘‘SEC. 2729A. REQUIREMENTS WITH RESPECT TO PRESCRIP- 17 TION DRUG COST-SHARING. 18 ‘‘(a) CREDIT TOWARDS DEDUCTIBLE.—With respect 19 to any enrollee in a health plan or individual or group 20 health insurance coverage who pays out-of-pocket for the 21 full cost of a prescription drug, the group health plan or 22 health insurance issuer offering such health insurance cov- 23 erage shall credit the full amount such enrollee paid for 24 VerDate Sep 11 2014 23:30 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S977.IS S977 kjohnson on DSK79L0C42 with BILLS 3 •S 977 IS such drug towards any deductible under the plan or cov- 1 erage applicable to prescription drugs. 2 ‘‘(b) ESTABLISHMENT OF CO-PAYMENTS FOR CER- 3 TAIN PRESCRIPTION DRUGS.— 4 ‘‘(1) IN GENERAL.—A group health plan or a 5 health insurance issuer offering group or individual 6 health insurance coverage shall, not later than 60 7 days before the first annual open enrollment period 8 after the date of enactment of the Transparent Drug 9 Pricing Act of 2019, and 60 days before each annual 10 open enrollment period thereafter, publish a list of 11 the co-payment amounts for the applicable plan year 12 with respect to each prescription drug covered under 13 the plan or coverage. 14 ‘‘(2) PROHIBITION ON CHANGES IN CO-PAY- 15 MENT AMOUNTS.—A group health plan or health in- 16 surance issuer described in paragraph (1) may not 17 change the co-payment amount published in accord- 18 ance with paragraph (1) until the next plan year. 19 ‘‘(3) CALCULATION OF OUT-OF-POCKET 20 COSTS.—A group health plan or a health insurance 21 issuer offering group or individual health insurance 22 coverage shall provide a mechanism that enables en- 23 rollees in the plan or coverage to determine the pro- 24 jected total out-of-pocket costs of an enrollee in the 25 VerDate Sep 11 2014 23:30 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S977.IS S977 kjohnson on DSK79L0C42 with BILLS 4 •S 977 IS plan or coverage for each prescription drug covered 1 under such plan or coverage.’’. 2 SEC. 4. INTERNATIONAL RETAIL LIST PRICE INDEX. 3 (a) IN GENERAL.—The retail list price in the United 4 States for a drug approved under subsection (c) or (j) of 5 section 505 of the Federal Food, Drug, and Cosmetic Act 6 (21 U.S.C. 355) or a biological product licensed under 7 subsection (a) or (k) of section 351 of the Public Health 8 Service Act (42 U.S.C. 262) may not exceed the lowest 9 retail list price for the drug among Canada, France, the 10 United Kingdom, Japan, or Germany. 11 (b) SUNSET.—The requirement under subsection (a) 12 shall terminate on the date that is 5 years after the date 13 of enactment of this Act. 14 Æ VerDate Sep 11 2014 23:30 Apr 05, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S977.IS S977 kjohnson on DSK79L0C42 with BILLS