[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1300 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1300
To prohibit a health plan from contracting with a pharmacy benefit
manager (PBM) unless the PBM satisfies certain requirements, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 19, 2003
Ms. Cantwell introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To prohibit a health plan from contracting with a pharmacy benefit
manager (PBM) unless the PBM satisfies certain requirements, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Prescription Drug Consumer
Information Act of 2003''.
SEC. 2. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.
(a) Amendments to the Public Health Service Act Relating to the
Group Market.--
(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:
``SEC. 2707. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.
``Notwithstanding any other provision of law, a group health plan,
and a health insurance issuer providing health insurance coverage in
connection with a group health plan, 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 insurance coverage, or to control the costs of such
prescription drug coverage, unless the PBM satisfies the following
requirements:
``(1) The PBM is not owned by a pharmaceutical
manufacturing company.
``(2) The PBM agrees to pass along any cost savings
negotiated with a pharmacy to the group health plan or the
health insurance issuer.
``(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 group health plan or the health insurance
issuer on a drug-by-drug basis.
``(4) The PBM agrees to provide, at least annually, the
group health plan or the health insurance issuer with all
financial and utilization information requested by the plan or
issuer relating to the provision of benefits to eligible
enrollees through the PBM and all financial and utilization
information relating to services provided to the plan or
issuer. 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 or
issuer under this paragraph may not be disclosed to any person
without the consent of the PBM.
``(5) The PBM agrees to provide, at least annually, the
group health plan or the health insurance issuer 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 pharmacy network fees that are charged from retail
pharmacies and data sales fees.''.
(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.
(b) Amendment to the Public Health Service Act Relating to the
Individual Market.--
(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--
(A) by redesignating such subpart as subpart 2; and
(B) by adding at the end the following:
``SEC. 2753. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.
``The provisions of section 2707 shall apply to health insurance
coverage offered by a health insurance issuer in the individual market
in the same manner as they apply to a group health plan and a health
insurance issuer providing health insurance coverage under that
section.''.
(2) Effective date.--The amendment made by paragraph (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.
(c) Employee Retirement Income Security Act of 1974.--
(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:
``SEC. 714. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.
``The provisions of section 2707 of the Public Health Service 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 a group health
plan and a health insurance issuer providing health insurance coverage
under that section.''.
(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:
``Sec. 714. Pharmacy benefit managers transparency requirements.''.
(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.
SEC. 3. DISCLOSURE OF RETAIL PRICES OF PHARMACEUTICALS.
The Secretary of Health and Human Services shall promulgate
regulations requiring a pharmacy to disclose the retail cost of a
prescription drug upon request by a consumer.
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