Public Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act

IIB 116TH CONGRESS 1ST SESSION H. R. 2115 IN THE SENATE OF THE UNITED STATES OCTOBER 29, 2019 Received; read twice and referred to the Committee on Finance AN ACT To amend titles XI and XVIII of the Social Security Act to provide greater transparency for discounts provided by manufacturers, to include real-time benefit informa- tion as part of a prescription drug plan’s electronic pre- scription program under the Medicare program, and for other purposes. VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS 2 HR 2115 RFS 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 ‘‘Public Disclosure of 4 Drug Discounts and Real-Time Beneficiary Drug Cost 5 Act’’. 6 SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS. 7 Section 1150A of the Social Security Act (42 U.S.C. 8 1320b–23) is amended— 9 (1) in subsection (c), in the matter preceding 10 paragraph (1), by inserting ‘‘(other than as per- 11 mitted under subsection (e))’’ after ‘‘disclosed by the 12 Secretary’’; and 13 (2) by adding at the end the following new sub- 14 section: 15 ‘‘(e) PUBLIC AVAILABILITY OF CERTAIN INFORMA- 16 TION.— 17 ‘‘(1) IN GENERAL.—In order to allow the com- 18 parison of PBMs’ ability to negotiate rebates, dis- 19 counts, direct and indirect remuneration fees, ad- 20 ministrative fees, and price concessions and the 21 amount of such rebates, discounts, direct and indi- 22 rect remuneration fees, administrative fees, and 23 price concessions that are passed through to plan 24 sponsors, beginning January 1, 2020, the Secretary 25 VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS 3 HR 2115 RFS shall make available on the Internet website of the 1 Department of Health and Human Services the in- 2 formation with respect to the second preceding cal- 3 endar year provided to the Secretary on generic dis- 4 pensing rates (as described in paragraph (1) of sub- 5 section (b)) and information provided to the Sec- 6 retary under paragraphs (2) and (3) of such sub- 7 section that, as determined by the Secretary, is with 8 respect to each PBM. 9 ‘‘(2) AVAILABILITY OF DATA.—In carrying out 10 paragraph (1), the Secretary shall ensure the fol- 11 lowing: 12 ‘‘(A) CONFIDENTIALITY.—The information 13 described in such paragraph is displayed in a 14 manner that prevents the disclosure of informa- 15 tion, with respect to an individual drug or an 16 individual plan, on rebates, discounts, direct 17 and indirect remuneration fees, administrative 18 fees, and price concessions. 19 ‘‘(B) CLASS OF DRUG.—The information 20 described in such paragraph is made available 21 by class of drug, using an existing classification 22 system, but only if the class contains such num- 23 ber of drugs, as specified by the Secretary (but 24 not fewer than three drugs), to ensure confiden- 25 VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS 4 HR 2115 RFS tiality of proprietary information or other infor- 1 mation that is prevented to be disclosed under 2 subparagraph (A).’’. 3 SEC. 3. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS 4 TO INCLUDE REAL-TIME BENEFIT INFORMA- 5 TION AS PART OF SUCH SPONSOR’S ELEC- 6 TRONIC PRESCRIPTION PROGRAM UNDER 7 THE MEDICARE PROGRAM. 8 Section 1860D–4(e)(2) of the Social Security Act (42 9 U.S.C. 1395w–104(e)(2)) is amended— 10 (1) in subparagraph (D), by striking ‘‘To the 11 extent’’ and inserting ‘‘Except as provided in sub- 12 paragraph (F), to the extent’’; and 13 (2) by adding at the end the following new sub- 14 paragraph: 15 ‘‘(F) REAL-TIME BENEFIT INFORMA- 16 TION.— 17 ‘‘(i) IN GENERAL.—Not later than 18 January 1, 2021, the program shall imple- 19 ment real-time benefit tools that are capa- 20 ble of integrating with a prescribing health 21 care professional’s electronic prescribing or 22 electronic health record system for the 23 transmission of formulary and benefit in- 24 formation in real time to prescribing health 25 VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS 5 HR 2115 RFS care professionals. With respect to a cov- 1 ered part D drug, such tools shall be capa- 2 ble of transmitting such information spe- 3 cific to an individual enrolled in a prescrip- 4 tion drug plan. Such information shall in- 5 clude the following: 6 ‘‘(I) A list of any clinically-appro- 7 priate alternatives to such drug in- 8 cluded in the formulary of such plan. 9 ‘‘(II) Cost-sharing information 10 for such drug and such alternatives, 11 including a description of any vari- 12 ance in cost sharing based on the 13 pharmacy dispensing such drug or 14 such alternatives. 15 ‘‘(III) Information relating to 16 whether such drug is included in the 17 formulary of such plan and any prior 18 authorization or other utilization man- 19 agement requirements applicable to 20 such drug and such alternatives so in- 21 cluded. 22 ‘‘(ii) ELECTRONIC TRANSMISSION.— 23 The provisions of subclauses (I) and (II) of 24 clause (ii) of subparagraph (E) shall apply 25 VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS 6 HR 2115 RFS to an electronic transmission described in 1 clause (i) in the same manner as such pro- 2 visions apply with respect to an electronic 3 transmission described in clause (i) of such 4 subparagraph. 5 ‘‘(iii) SPECIAL RULE FOR 2021.—The 6 program shall be deemed to be in compli- 7 ance with clause (i) for 2021 if the pro- 8 gram complies with the provisions of sec- 9 tion 423.160(b)(7) of title 42, Code of 10 Federal Regulations (or a successor regula- 11 tion), for such year. 12 ‘‘(iv) RULE OF CONSTRUCTION.— 13 Nothing in this subparagraph shall be con- 14 strued as to allow a real-time benefits tool 15 to steer an individual, without the consent 16 of the individual, to a particular pharmacy 17 or pharmacy setting over their preferred 18 pharmacy setting nor prohibit the designa- 19 tion of a preferred pharmacy under such 20 tool.’’. 21 SEC. 4. SENSE OF CONGRESS REGARDING THE NEED TO EX- 22 PAND COMMERCIALLY AVAILABLE DRUG 23 PRICING COMPARISON PLATFORMS. 24 It is the sense of Congress that— 25 VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS 7 HR 2115 RFS (1) commercially available drug pricing com- 1 parison platforms can, at no cost, help patients find 2 the lowest price for their medications at their local 3 pharmacy; 4 (2) such platforms should be integrated, to the 5 maximum extent possible, in the health care delivery 6 ecosystem; and 7 (3) pharmacy benefit managers should work to 8 disclose generic and brand name drug prices to such 9 platforms to ensure that— 10 (A) patients can benefit from the lowest 11 possible price available to them; and 12 (B) overall drug prices can be reduced as 13 more educated purchasing decisions are made 14 based on price transparency. 15 Passed the House of Representatives October 28, 2019. Attest: CHERYL L. JOHNSON, Clerk. VerDate Sep 11 2014 00:17 Oct 30, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2115.RFS H2115 kjohnson on DSK79L0C42 with BILLS