II 

116TH CONGRESS 

1ST SESSION S. 476 

To amend titles XI and XVIII of the Social Security Act to provide greater 

transparency of discounts provided by drug manufacturers. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 13, 2019 

Mr. WYDEN (for himself, Mr. BROWN, Mr. CARPER, and Mr. TESTER) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XI and XVIII of the Social Security Act 

to provide greater transparency of discounts provided 

by drug manufacturers. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Creating Transparency 

5 to Have Drug Rebates Unlocked (C–THRU) Act of 

6 2019’’. 

7 SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS. 

8 (a) IN GENERAL.—Section 1150A of the Social Secu9 rity Act (42 U.S.C. 1320b–23) is amended— 


pbinns on DSK79D2C42PROD with BILLS
2 

•S 476 IS

1 (1) in subsection (c), in the matter preceding 

2 paragraph (1), by striking ‘‘this section’’ and insert3 ing ‘‘subsection (b)(1)’’; and 

4 (2) by adding at the end the following new sub5 section: 

6 ‘‘(e) PUBLIC AVAILABILITY OF CERTAIN INFORMA7 TION.—In order to allow patients and employers to com8 pare PBMs’ ability to negotiate rebates, discounts, and 

9 price concessions and the amount of such rebates, dis10 counts, and price concessions that are passed through to 

11 plan sponsors, beginning January 1, 2020, the Secretary 

12 shall make available on the Internet website of the Depart13 ment of Health and Human Services the information pro14 vided to the Secretary under paragraphs (2) and (3) of 

15 subsection (b) with respect to each PBM. The Secretary 

16 shall ensure that such information is displayed in a man17 ner that prevents the disclosure of information on rebates, 

18 discounts, and price concessions with respect to an indi19 vidual drug or an individual plan.’’. 

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

21 subsection (a) shall take effect on January 1, 2020. 


pbinns on DSK79D2C42PROD with BILLS
3 

•S 476 IS

1 SEC. 3. MINIMUM DRUG DISCOUNTS REQUIRED TO BE 

2 PASSED THROUGH TO THE PLAN SPONSOR. 

3 (a) IN GENERAL.—Section 1150A of the Social Secu4 rity Act (42 U.S.C. 1320b–23), as amended by section 

5 2(a)(2), is amended— 

6 (1) in the heading, by inserting ‘‘; MINIMUM

7 DRUG DISCOUNTS REQUIRED TO BE PASSED

8 THROUGH TO THE PLAN SPONSOR’’ before the 

9 period at the end; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(f) MINIMUM DRUG DISCOUNTS REQUIRED TO BE

13 PASSED THROUGH TO THE PLAN SPONSOR.— 

14 ‘‘(1) REQUIREMENT.—Beginning January 1, 

15 2022, a PBM that manages prescription drug cov16 erage under a contract with a PDP sponsor or MA 

17 organization described in subsection (b)(1) or a 

18 qualified health benefits plan described in subsection 

19 (b)(2), shall, with respect to the plan sponsor of a 

20 health benefits plan, pass through to the plan spon21 sor a minimum percent (as established by the Sec22 retary) of the aggregate amount of the rebates, dis23 counts, or price concessions that the PBM nego24 tiates that are attributable to patient utilization 

25 under the plan. 


pbinns on DSK79D2C42PROD with BILLS
4 

•S 476 IS

1 ‘‘(2) ESTABLISHMENT.—The Secretary shall es2 tablish the minimum percent described in paragraph 

3 (1) in such a manner as will ensure that patients re4 ceive the maximum benefit of rebates, discounts, or 

5 price concessions while taking into account the costs 

6 of negotiating such rebates, discounts, and price 

7 concessions. 

8 ‘‘(3) ENFORCEMENT.—A PDP sponsor of a 

9 prescription drug plan or an MA organization offer10 ing an MA–PD plan under part D of title XVIII 

11 may not contract with a PBM that is not in compli12 ance with the requirement under paragraph (1).’’. 

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

14 subsection (a) shall take effect on January 1, 2022. 

15 SEC. 4. PART D NEGOTIATED PRICES REQUIRED TO TAKE 

16 INTO ACCOUNT ALL PRICE CONCESSIONS AT 

17 THE POINT-OF-SALE. 

18 (a) IN GENERAL.—Section 1860D–2(d)(1)(B) of the 

19 Social Security Act (42 U.S.C. 1395w–102(d)(1)(B)) is 

20 amended— 

21 (1) by striking ‘‘PRICES.—For purposes’’ and 

22 inserting ‘‘PRICES.— 

23 ‘‘(i) IN GENERAL.—For purposes’’; 

24 and 


pbinns on DSK79D2C42PROD with BILLS
5 

•S 476 IS

1 (2) by adding at the end the following new 

2 clause: 

3 ‘‘(ii) NEGOTIATED PRICES AT POINT4 OF-SALE.— 

5 ‘‘(I) IN GENERAL.—Negotiated 

6 prices for covered part D drugs de7 scribed in clause (i), including all 

8 price negotiated concessions, shall be 

9 provided at the point-of-sale of the 

10 covered part D drug. If the negotiated 

11 price, including all negotiated price 

12 concessions, is not possible to cal13 culate at the point-of-sale, an approxi14 mate negotiated price (as established 

15 by the Secretary) shall be used under 

16 the prescription drug plan or MA–PD 

17 plan. 

18 ‘‘(II) APPROXIMATE NEGOTIATED

19 PRICE.—In determining an approxi20 mate negotiated price for a covered 

21 part D drug under subclause (I), the 

22 Secretary shall ensure that— 

23 ‘‘(aa) such price reflects the 

24 estimated negotiated price that is 

25 based on the previous year’s neVerDate Sep 11 2014 22:25 Feb 26, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S476.IS S476

pbinns on DSK79D2C42PROD with BILLS
6 

•S 476 IS

1 gotiated price concessions nego2 tiated under the plan for all or 

3 similar covered part D drugs or 

4 is based on such other factors as 

5 the Secretary may determine ap6 propriate; and 

7 ‘‘(bb) the use of such price 

8 does not prevent the use of value9 based contracts between drug 

10 manufacturers, PDP sponsors, 

11 MA organizations, and phar12 macies.’’. 

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

14 subsection (a) shall apply to plan years beginning on or 

15 after January 1, 2021. 

Æ 


pbinns on DSK79D2C42PROD with BILLS