A bill to increase transparency and access to group health plan and health insurance issuer reporting, and for other purposes.

II 116TH CONGRESS 2D SESSION S. 5084 To increase transparency and access to group health plan and health insurance issuer reporting, and for other purposes. IN THE SENATE OF THE UNITED STATES DECEMBER 21, 2020 Mr. BRAUN introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To increase transparency and access to group health plan and health insurance issuer reporting, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. REPORTING ON PHARMACY BENEFITS AND 3 DRUG COSTS. 4 (a) PHSA.—Subpart II of part A of title XXVII of 5 the Public Health Service Act (42 U.S.C. 300gg–11 et 6 seq.) is amended by adding at the end the following: 7 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 5084 IS ‘‘SEC. 2729A. REPORTING ON PHARMACY BENEFITS AND 1 DRUG COSTS. 2 ‘‘(a) IN GENERAL.—Not later than 1 year after the 3 date of enactment of this section, and not later than 4 March 1 of each year thereafter, a group health plan or 5 health insurance issuer offering group or individual health 6 insurance coverage (except for a church plan) shall submit 7 to the Secretary, the Secretary of Labor, and the Sec- 8 retary of the Treasury the following information with re- 9 spect to the health plan or coverage in the previous plan 10 year: 11 ‘‘(1) The beginning and end dates of the plan 12 year. 13 ‘‘(2) The number of enrollees. 14 ‘‘(3) Each State in which the plan or coverage 15 is offered. 16 ‘‘(4) The 50 brand prescription drugs most fre- 17 quently dispensed by pharmacies for claims paid by 18 the plan or coverage, and the total number of paid 19 claims for each such drug. 20 ‘‘(5) The 50 most costly prescription drugs with 21 respect to the plan or coverage by total annual 22 spending, and the annual amount spent by the plan 23 or coverage for each such drug. 24 ‘‘(6) The 50 prescription drugs with the great- 25 est increase in plan expenditures over the plan year 26 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 5084 IS preceding the plan year that is the subject of the re- 1 port, and, for each such drug, the change in 2 amounts expended by the plan or coverage in each 3 such plan year. 4 ‘‘(7) Total spending on health care services by 5 such group health plan or health insurance coverage, 6 broken down by— 7 ‘‘(A) the type of costs, including— 8 ‘‘(i) hospital costs; 9 ‘‘(ii) health care provider and clinical 10 service costs, for primary care and spe- 11 cialty care separately; 12 ‘‘(iii) costs for prescription drugs; and 13 ‘‘(iv) other medical costs, including 14 wellness services; and 15 ‘‘(B) spending on prescription drugs by— 16 ‘‘(i) the health plan or coverage; and 17 ‘‘(ii) the enrollees. 18 ‘‘(8) The average monthly premium— 19 ‘‘(A) paid by employers on behalf of enroll- 20 ees, as applicable; and 21 ‘‘(B) paid by enrollees. 22 ‘‘(9) Any impact on premiums by rebates, fees, 23 and any other remuneration paid by drug manufac- 24 turers to the plan or coverage or its administrators 25 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 5084 IS or service providers, with respect to prescription 1 drugs prescribed to enrollees in the plan or coverage, 2 including— 3 ‘‘(A) the amounts so paid for each thera- 4 peutic class of drugs; and 5 ‘‘(B) the amounts so paid for each of the 6 25 drugs that yielded the highest amount of re- 7 bates and other remuneration under the plan or 8 coverage from drug manufacturers during the 9 plan year. 10 ‘‘(10) Any reduction in premiums and out-of- 11 pocket costs associated with rebates, fees, or other 12 remuneration described in paragraph (9). 13 ‘‘(b) REPORT.—Not later than 18 months after the 14 date on which the first report is required under subsection 15 (a) and biannually thereafter, the Secretary, acting 16 through the Assistant Secretary of Planning and Evalua- 17 tion and in coordination with the Inspector General of the 18 Department of Health and Human Services, shall make 19 available on the internet website of the Department of 20 Health and Human Services a report on prescription drug 21 reimbursements under group health plans and group and 22 individual health insurance coverage, prescription drug 23 pricing trends, and the role of prescription drug costs in 24 contributing to premium increases or decreases under such 25 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 5084 IS plans or coverage, aggregated in such a way as no drug 1 or plan specific information will be made public. 2 ‘‘(c) PRIVACY PROTECTIONS.—No confidential or 3 trade secret information submitted to the Secretary under 4 subsection (a) shall be included in the report under sub- 5 section (b).’’. 6 (b) ERISA.—Subpart B of part 7 of subtitle B of 7 title I of the Employee Retirement Income Security Act 8 of 1974 (29 U.S.C. 1185 et seq.) is amended by adding 9 at the end the following: 10 ‘‘SEC. 716. REPORTING ON PHARMACY BENEFITS AND 11 DRUG COSTS. 12 ‘‘(a) IN GENERAL.—Not later than 1 year after the 13 date of enactment of this section, and not later than 14 March 1 of each year thereafter, a group health plan (or 15 health insurance coverage offered in connection with such 16 a plan) shall submit to the Secretary, the Secretary of 17 Health and Human Services, and the Secretary of the 18 Treasury the following information with respect to the 19 health plan or coverage in the previous plan year: 20 ‘‘(1) The beginning and end dates of the plan 21 year. 22 ‘‘(2) The number of participants and bene- 23 ficiaries. 24 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 5084 IS ‘‘(3) Each State in which the plan or coverage 1 is offered. 2 ‘‘(4) The 50 brand prescription drugs most fre- 3 quently dispensed by pharmacies for claims paid by 4 the plan or coverage, and the total number of paid 5 claims for each such drug. 6 ‘‘(5) The 50 most costly prescription drugs with 7 respect to the plan or coverage by total annual 8 spending, and the annual amount spent by the plan 9 or coverage for each such drug. 10 ‘‘(6) The 50 prescription drugs with the great- 11 est increase in plan expenditures over the plan year 12 preceding the plan year that is the subject of the re- 13 port, and, for each such drug, the change in 14 amounts expended by the plan or coverage in each 15 such plan year. 16 ‘‘(7) Total spending on health care services by 17 such group health plan or health insurance coverage, 18 broken down by— 19 ‘‘(A) the type of costs, including— 20 ‘‘(i) hospital costs; 21 ‘‘(ii) health care provider and clinical 22 service costs, for primary care and spe- 23 cialty care separately; 24 ‘‘(iii) costs for prescription drugs; and 25 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 5084 IS ‘‘(iv) other medical costs, including 1 wellness services; and 2 ‘‘(B) spending on prescription drugs by— 3 ‘‘(i) the health plan or coverage; and 4 ‘‘(ii) the participants and bene- 5 ficiaries. 6 ‘‘(8) The average monthly premium— 7 ‘‘(A) paid by employers on behalf of par- 8 ticipants and beneficiaries, as applicable; and 9 ‘‘(B) paid by participants and bene- 10 ficiaries. 11 ‘‘(9) Any impact on premiums by rebates, fees, 12 and any other remuneration paid by drug manufac- 13 turers to the plan or coverage or its administrators 14 or service providers, with respect to prescription 15 drugs prescribed to participants or beneficiaries in 16 the plan or coverage, including— 17 ‘‘(A) the amounts so paid for each thera- 18 peutic class of drugs; and 19 ‘‘(B) the amounts so paid for each of the 20 25 drugs that yielded the highest amount of re- 21 bates and other remuneration under the plan or 22 coverage from drug manufacturers during the 23 plan year. 24 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 5084 IS ‘‘(10) Any reduction in premiums and out-of- 1 pocket costs associated with rebates, fees, or other 2 remuneration described in paragraph (9). 3 ‘‘(b) REPORT.—Not later than 18 months after the 4 date on which the first report is required under subsection 5 (a) and biannually thereafter, the Secretary, acting in co- 6 ordination with the Inspector General of the Department 7 of Labor, shall make available on the internet website of 8 the Department of Labor a report on prescription drug 9 reimbursements under group health plans (or health in- 10 surance coverage offered in connection with such a plan), 11 prescription drug pricing trends, and the role of prescrip- 12 tion drug costs in contributing to premium increases or 13 decreases under such plans or coverage, aggregated in 14 such a way as no drug or plan specific information will 15 be made public. 16 ‘‘(c) PRIVACY PROTECTIONS.—No confidential or 17 trade secret information submitted to the Secretary under 18 subsection (a) shall be included in the report under sub- 19 section (b).’’. 20 (c) IRC.—Subchapter B of chapter 100 of the Inter- 21 nal Revenue Code of 1986 is amended by adding at the 22 end the following: 23 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 5084 IS ‘‘SEC. 9816. REPORTING ON PHARMACY BENEFITS AND 1 DRUG COSTS. 2 ‘‘(a) IN GENERAL.—Not later than 1 year after the 3 date of enactment of this section, and not later than 4 March 1 of each year thereafter, a group health plan shall 5 submit to the Secretary, the Secretary of Health and 6 Human Services, and the Secretary of Labor the following 7 information with respect to the health plan in the previous 8 plan year: 9 ‘‘(1) The beginning and end dates of the plan 10 year. 11 ‘‘(2) The number of participants and bene- 12 ficiaries. 13 ‘‘(3) Each State in which the plan is offered. 14 ‘‘(4) The 50 brand prescription drugs most fre- 15 quently dispensed by pharmacies for claims paid by 16 the plan, and the total number of paid claims for 17 each such drug. 18 ‘‘(5) The 50 most costly prescription drugs with 19 respect to the plan by total annual spending, and the 20 annual amount spent by the plan for each such 21 drug. 22 ‘‘(6) The 50 prescription drugs with the great- 23 est increase in plan expenditures over the plan year 24 preceding the plan year that is the subject of the re- 25 port, and, for each such drug, the change in 26 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 5084 IS amounts expended by the plan in each such plan 1 year. 2 ‘‘(7) Total spending on health care services by 3 such group health plan, broken down by— 4 ‘‘(A) the type of costs, including— 5 ‘‘(i) hospital costs; 6 ‘‘(ii) health care provider and clinical 7 service costs, for primary care and spe- 8 cialty care separately; 9 ‘‘(iii) costs for prescription drugs; and 10 ‘‘(iv) other medical costs, including 11 wellness services; and 12 ‘‘(B) spending on prescription drugs by— 13 ‘‘(i) the health plan; and 14 ‘‘(ii) the participants and bene- 15 ficiaries. 16 ‘‘(8) The average monthly premium— 17 ‘‘(A) paid by employers on behalf of par- 18 ticipants and beneficiaries, as applicable; and 19 ‘‘(B) paid by participants and bene- 20 ficiaries. 21 ‘‘(9) Any impact on premiums by rebates, fees, 22 and any other remuneration paid by drug manufac- 23 turers to the plan or its administrators or service 24 providers, with respect to prescription drugs pre- 25 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 5084 IS scribed to participants or beneficiaries in the plan, 1 including— 2 ‘‘(A) the amounts so paid for each thera- 3 peutic class of drugs; and 4 ‘‘(B) the amounts so paid for each of the 5 25 drugs that yielded the highest amount of re- 6 bates and other remuneration under the plan 7 from drug manufacturers during the plan year. 8 ‘‘(10) Any reduction in premiums and out-of- 9 pocket costs associated with rebates, fees, or other 10 remuneration described in paragraph (9). 11 ‘‘(b) REPORT.—Not later than 18 months after the 12 date on which the first report is required under subsection 13 (a) and biannually thereafter, the Secretary, acting in co- 14 ordination with the Inspector General of the Department 15 of the Treasury, shall make available on the internet 16 website of the Department of the Treasury a report on 17 prescription drug reimbursements under group health 18 plans, prescription drug pricing trends, and the role of 19 prescription drug costs in contributing to premium in- 20 creases or decreases under such plans, aggregated in such 21 a way as no drug or plan specific information will be made 22 public. 23 ‘‘(c) PRIVACY PROTECTIONS.—No confidential or 24 trade secret information submitted to the Secretary under 25 VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 5084 IS subsection (a) shall be included in the report under sub- 1 section (b).’’. 2 (d) CLERICAL AMENDMENTS.— 3 (1) ERISA.—The table of contents in section 1 4 of the Employee Retirement Income Security Act of 5 1974 (29 U.S.C. 1001 et seq.) is amended by insert- 6 ing after the item relating to section 714 the fol- 7 lowing new items: 8 ‘‘Sec. 715. Additional market reforms. ‘‘Sec. 716. Reporting on pharmacy benefits and drug costs.’’. (2) IRC.—The table of sections for subchapter 9 B of chapter 100 of the Internal Revenue Code of 10 1986 is amended by adding at the end the following 11 new item: 12 ‘‘Sec. 9816. Reporting on pharmacy benefits and drug costs.’’. Æ VerDate Sep 11 2014 18:17 Jan 13, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S5084.IS S5084 pamtmann on DSKBC07HB2PROD with BILLS