To prohibit an eligible entity offering a Medicare Prescription Drug plan, a MedicareAdvantage Organization offering a MedicareAdvantage plan, and other health plans from contracting with a pharmacy benefit manager (PBM) unless the PBM satisfies certain requirements.

1. Adds SEC. 133. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS on page 204, line 22

   Adds a sectionPrinted page

   Inserted: SEC. 133. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

   Inserted: (a) Medicare.--Subpart 3 of part D of title XVIII of the Social Security Act (as added by section 101) is amended by adding at the end the following new section:

   Inserted: "pharmacy benefit managers transparency requirements

   Inserted: "Sec. 1860D-27. Notwithstanding any other provision of law, an eligible entity offering a Medicare Prescription Drug plan under this part or a MedicareAdvantage organization offering a MedicareAdvantage plan under part C shall not enter into a contract with any pharmacy benefit manager (in this section referred to as a 'PBM') to manage the prescription drug coverage provided under such plan, or to control the costs of such coverage, unless the PBM satisfies the following requirements:

   Inserted: "(1) The PBM is not owned by a pharmaceutical manufacturing company.

   Inserted: "(2) The PBM agrees to pass along any cost savings negotiated with a pharmacy to the Medicare Prescription Drug plan or the MedicareAdvantage plan.

   Inserted: "(3) The PBM agrees to make public on an annual basis the percent of manufacturer's rebates received by the PBM that is passed back to the Medicare Prescription Drug plan or the MedicareAdvantage plan on a drug-by-drug basis.

   Inserted: "(4) The PBM agrees to provide, at least annually, the Medicare Prescription Drug plan or the MedicareAdvantage plan with all financial and utilization information requested by the plan relating to the provision of benefits to eligible beneficiaries through the PBM and all financial and utilization information relating to services provided to the plan. A PBM providing information under this paragraph may designate that information as confidential. Information designated as confidential by a PBM and provided to a plan under this paragraph may not be disclosed to any person without the consent of the PBM.

   Inserted: "(5) The PBM agrees to provide, at least annually, the Medicare Prescription Drug plan or the MedicareAdvantage plan with all financial terms and arrangements for remuneration of any kind that apply between the PBM and any prescription drug manufacturer or labeler, including formulary management and drug-switch programs, educational support, claims processing and

   Inserted: pharmacy network fees that are charged from retail pharmacies and data sales fees.

   Inserted: "(6) The PBM agrees to disclose the retail cost of a prescription drug upon request by a consumer.".

   Inserted: (b) Employee Retirement Income Security Act of 1974.--

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   Inserted: (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:

   Inserted: "SEC. 714. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

   Inserted: "The provisions of section 1860D-27 of the Social Security Act shall apply to a group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, in the same manner as such provisions apply to an eligible entity offering a Medicare Prescription Drug plan under part D of title XVIII of the Social Security Act or to a MedicareAdvantage organization offering a MedicareAdvantage plan under part C of title XVIII of that Act.".

   Inserted: (2) Clerical amendment.--The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 713 the following:

   Inserted: "Sec. 714. Pharmacy benefit managers transparency requirements.".

   Inserted: (3) Effective dates.--The amendments made by this subsection shall apply with respect to plan years beginning on or after the date of enactment of this Act.

   Inserted: (c) Amendments to the Public Health Service Act Relating to the Group Market.--

   Inserted: (1) In general.--Subpart 2 of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end the following:

   Inserted: "SEC. 2707. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

   Inserted: "The provisions of section 1860D-27 of the Social Security Act shall apply to a group health plan and a health insurance issuer providing health insurance coverage in connection with a group health plan, in the same manner as such provisions apply to an eligible entity offering a Medicare Prescription Drug plan under part D of title XVIII of the Social Security Act or to a MedicareAdvantage organization offering a MedicareAdvantage plan under part C of title XVIII of that Act.".

   Inserted: (2) Effective date.--The amendment made by this subsection shall apply to group health plans and health insurance issuers in connection with group health plans for plan years beginning on or after the date of enactment of this Act.

   Inserted: (d) Amendment to the Public Health Service Act Relating to the Individual Market.--

   Inserted: (1) In general.--The first subpart 3 of part B of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-51 et seq.) is amended--

   Inserted: (A) by redesignating such subpart as subpart 2; and

   Inserted: (B) by adding at the end the following:

   Inserted: "SEC. 2753. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

   Inserted: "The provisions of section 1860D-27 of the Social Security Act shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to an eligible entity offering a Medicare Prescription Drug plan under part D of title XVIII of the Social Security Act or to a MedicareAdvantage organization offering a MedicareAdvantage plan under part C of title XVIII of that Act.".

   Inserted: (2) Effective date.--The amendment made by subsection (c)(1)(B) shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after the date of enactment of this Act.

   Inserted: (e) Amendments to the Internal Revenue Code of 1986.--

   Inserted: (1) In general.--Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after section 9812 the following:

   Inserted: "SEC. 9813. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.

   Inserted: "The provisions of section 1860D-27 of the Social Security Act shall apply to a group health plan in the same manner as they apply to an eligible entity offering a Medicare Prescription Drug plan under part D of title XVIII of the Social Security Act or to a MedicareAdvantage organization offering a MedicareAdvantage plan under part C of title XVIII of that Act.".

   Inserted: (2) Clerical Amendment.--The table of contents for chapter 100 of such Code is amended by inserting after the item relating to section 9812 the following

   Inserted: "Sec. 9813. Required coverage of young adults.".

   Inserted: (3) Effective date.--The amendments made by this subsection shall apply with respect to plan years beginning on or after the date of enactment of this Act.

   Original wording

   On page 204, after line 22, insert the following:

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As printed