To limit application of the gag clause to self-insured group health plans.

SA 4011. Mr. LEE submitted an amendment intended to be proposed by
him to the bill S. 2554, to ensure that health insurance issuers and
group health plans do not prohibit pharmacy providers from providing
certain information to enrollees; which was ordered to lie on the
table; as follows:

On page 4, strike line 2 and all that follows through line
6 on page 5 and insert the following:
``(a) In General.--A self-insured group health plan shall--
``(1) not restrict, directly or indirectly, any pharmacy
that dispenses a prescription drug to an enrollee in the plan
from informing (or penalize such pharmacy for informing) an
enrollee of any differential between the enrollee's out-of-
pocket cost under the plan with respect to acquisition of the
drug and the amount an individual would pay for acquisition
of the drug without using the plan; and
``(2) ensure that any entity that provides pharmacy
benefits management services under a contract with any such
health plan does not, with respect to such plan, restrict,
directly or indirectly, a pharmacy that dispenses a
prescription drug from informing (or penalize such pharmacy
for informing) an enrollee of any differential between the
enrollee's out-of-pocket cost under the plan with respect to
acquisition of the drug and the amount an individual would
pay for acquisition of the drug without using the plan.
``(b) Definition.--For purposes of this section, the term
`out-of-pocket cost', with respect to acquisition of a drug,
means the amount to be paid by the enrollee under the health
plan, including any cost-sharing (including any deductible,
copayment, or coinsurance) and, as determined by the
Secretary, any other expenditure.''.
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