I 

118TH CONGRESS 

2D SESSION H. R. 7717 

To amend title XI of the Social Security Act to enhance pharmacy benefit 

manager transparency requirements. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2024 

Mr. GALLEGO introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XI of the Social Security Act to enhance 

pharmacy benefit manager transparency requirements. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. ENHANCING PBM TRANSPARENCY REQUIRE4 MENTS. 

5 (a) IN GENERAL.—Section 1150A of the Social Secu6 rity Act (42 U.S.C. 1320b–23) is amended— 

7 (1) by striking subsection (a) and inserting the 

8 following: 

9 ‘‘(a) PROVISION OF INFORMATION.— 


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1 ‘‘(1) IN GENERAL.—The following entities shall 

2 provide the information described in subsection (b) 

3 to the Secretary and, in the case of an entity de4 scribed in subparagraph (B) or an affiliate of such 

5 entity described in subparagraph (C), to the health 

6 benefits plan with which the entity is under contract, 

7 at such times, and in such form and manner, as the 

8 Secretary shall specify: 

9 ‘‘(A) A health benefits plan. 

10 ‘‘(B) Any entity that provides pharmacy 

11 benefits management services on behalf of a 

12 health benefits plan (in this section referred to 

13 as a ‘PBM’) that manages prescription drug 

14 coverage under a contract with— 

15 ‘‘(i) a PDP sponsor of a prescription 

16 drug plan or an MA organization offering 

17 an MA–PD plan under part D of title 

18 XVIII; or 

19 ‘‘(ii) a qualified health benefits plan 

20 offered through an exchange established by 

21 a State under section 1311 of the Patient 

22 Protection and Affordable Care Act. 

23 ‘‘(C) Any affiliate of an entity described in 

24 subparagraph (B) that acts as a price nego25 tiator or group purchaser on behalf of such 


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1 PBM, PDP sponsor, MA organization, or quali2 fied health benefits plan. 

3 ‘‘(2) AFFILIATE DEFINED.—In this section, the 

4 term ‘affiliate’ means any entity that is owned by, 

5 controlled by, or related under a common ownership 

6 structure with a PBM (including an entity owned or 

7 controlled by the PDP sponsor of a prescription 

8 drug plan, MA organization offering an MA–PD 

9 plan, or qualified health benefits plan for which such 

10 entity is acting as a price negotiator or group pur11 chaser).’’; 

12 (2) in subsection (b)— 

13 (A) in paragraph (2), by inserting ‘‘and 

14 percentage’’ after ‘‘and the aggregate amount’’; 

15 and 

16 (B) by adding at the end the following new 

17 paragraph: 

18 ‘‘(4) The amount (in the aggregate and 

19 disaggregated by type) of all fees the PBM or an af20 filiate of the PBM receives from all pharmaceutical 

21 manufacturers in connection with patient utilization 

22 under the plan, and the amount and percentage (in 

23 the aggregate and disaggregated by type) of such 

24 fees that are passed through to the plan sponsor or 

25 issuer.’’; and 


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1 (3) by adding at the end the following new sub2 section: 

3 ‘‘(e) ANNUAL REPORT.—The Secretary shall make 

4 publicly available on the Internet website of the Centers 

5 for Medicare & Medicaid Services an annual report that 

6 summarizes the trends observed with respect to data re7 ported under subsection (b).’’. 

8 (b) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to plan or contract years beginning 

10 on or after January 1, 2027. 

11 (c) IMPLEMENTATION.—Notwithstanding any other 

12 provision of law, the Secretary may implement the amend13 ments made by this section by program instruction or oth14 erwise. 

15 (d) NON-APPLICATION OF THE PAPERWORK REDUC16 TION ACT.—Chapter 35 of title 44, United States Code 

17 (commonly referred to as the ‘‘Paperwork Reduction Act 

18 of 1995’’), shall not apply to the implementation of the 

19 amendments made by this section. 

Æ 


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