II 

116TH CONGRESS 

2D SESSION S. 4959 

To increase transparency and access to group health plan and health issuer 

reporting, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 3, 2020 

Mr. BRAUN introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To increase transparency and access to group health plan 

and health issuer reporting, and for other purposes. 

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

3 SECTION 1. REPORTING ON PHARMACY BENEFITS AND 

4 DRUG COSTS. 

5 (a) PSHA.—Subpart II of part A of title XXVII of 

6 the Public Health Service Act (42 U.S.C. 300gg–11 et 

7 seq.) is amended by adding at the end the following: 


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1 ‘‘SEC. 2729A. REPORTING ON PHARMACY BENEFITS AND 

2 DRUG COSTS. 

3 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

4 date of enactment of this section, and not later than 

5 March 1 of each year thereafter, a group health plan or 

6 health insurance issuer offering group or individual health 

7 insurance coverage (except for a church plan) shall submit 

8 to the Secretary, the Secretary of Labor, and the Sec9 retary of the Treasury the following information with re10 spect to the health plan or coverage in the previous plan 

11 year: 

12 ‘‘(1) The beginning and end dates of the plan 

13 year. 

14 ‘‘(2) The number of enrollees. 

15 ‘‘(3) Each State in which the plan or coverage 

16 is offered. 

17 ‘‘(4) The 50 brand prescription drugs most fre18 quently dispensed by pharmacies for claims paid by 

19 the plan or coverage, and the total number of paid 

20 claims for each such drug. 

21 ‘‘(5) The 50 most costly prescription drugs with 

22 respect to the plan or coverage by total annual 

23 spending, and the annual amount spent by the plan 

24 or coverage for each such drug. 

25 ‘‘(6) The 50 prescription drugs with the great26 est increase in plan expenditures over the plan year 


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1 preceding the plan year that is the subject of the re2 port, and, for each such drug, the change in 

3 amounts expended by the plan or coverage in each 

4 such plan year. 

5 ‘‘(7) Total spending on health care services by 

6 such group health plan or health insurance coverage, 

7 broken down by— 

8 ‘‘(A) the type of costs, including— 

9 ‘‘(i) hospital costs; 

10 ‘‘(ii) health care provider and clinical 

11 service costs, for primary care and spe12 cialty care separately; 

13 ‘‘(iii) costs for prescription drugs; and 

14 ‘‘(iv) other medical costs, including 

15 wellness services; and 

16 ‘‘(B) spending on prescription drugs by— 

17 ‘‘(i) the health plan or coverage; and 

18 ‘‘(ii) the enrollees. 

19 ‘‘(8) The average monthly premium— 

20 ‘‘(A) paid by employers on behalf of enroll21 ees, as applicable; and 

22 ‘‘(B) paid by enrollees. 

23 ‘‘(9) Any impact on premiums by rebates, fees, 

24 and any other remuneration paid by drug manufac25 turers to the plan or coverage or its administrators 


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1 or service providers, with respect to prescription 

2 drugs prescribed to enrollees in the plan or coverage, 

3 including— 

4 ‘‘(A) the amounts so paid for each thera5 peutic class of drugs; and 

6 ‘‘(B) the amounts so paid for each of the 

7 25 drugs that yielded the highest amount of re8 bates and other remuneration under the plan or 

9 coverage from drug manufacturers during the 

10 plan year. 

11 ‘‘(10) Any reduction in premiums and out-of12 pocket costs associated with rebates, fees, or other 

13 remuneration described in paragraph (9). 

14 ‘‘(b) REPORT.—Not later than 18 months after the 

15 date on which the first report is required under subsection 

16 (a) and biannually thereafter, the Secretary, acting 

17 through the Assistant Secretary of Planning and Evalua18 tion and in coordination with the Inspector General of the 

19 Department of Health and Human Services, shall make 

20 available on the internet website of the Department of 

21 Health and Human Services a report on prescription drug 

22 reimbursements under group health plans and group and 

23 individual health insurance coverage, prescription drug 

24 pricing trends, and the role of prescription drug costs in 

25 contributing to premium increases or decreases under such 


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1 plans or coverage, aggregated in such a way as no drug 

2 or plan specific information will be made public. 

3 ‘‘(c) PRIVACY PROTECTIONS.—No confidential or 

4 trade secret information submitted to the Secretary under 

5 subsection (a) shall be included in the report under sub6 section (b).’’. 

7 (b) ERISA.—Subpart B of part 7 of subtitle B of 

8 title I of the Employee Retirement Income Security Act 

9 of 1974 (29 U.S.C. 1185 et seq.) is amended by adding 

10 at the end the following: 

11 ‘‘SEC. 716. REPORTING ON PHARMACY BENEFITS AND 

12 DRUG COSTS. 

13 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

14 date of enactment of this section, and not later than 

15 March 1 of each year thereafter, a group health plan (or 

16 health insurance coverage offered in connection with such 

17 a plan) shall submit to the Secretary, the Secretary of 

18 Health and Human Services, and the Secretary of the 

19 Treasury the following information with respect to the 

20 health plan or coverage in the previous plan year: 

21 ‘‘(1) The beginning and end dates of the plan 

22 year. 

23 ‘‘(2) The number of participants and bene24 ficiaries. 


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1 ‘‘(3) Each State in which the plan or coverage 

2 is offered. 

3 ‘‘(4) The 50 brand prescription drugs most fre4 quently dispensed by pharmacies for claims paid by 

5 the plan or coverage, and the total number of paid 

6 claims for each such drug. 

7 ‘‘(5) The 50 most costly prescription drugs with 

8 respect to the plan or coverage by total annual 

9 spending, and the annual amount spent by the plan 

10 or coverage for each such drug. 

11 ‘‘(6) The 50 prescription drugs with the great12 est increase in plan expenditures over the plan year 

13 preceding the plan year that is the subject of the re14 port, and, for each such drug, the change in 

15 amounts expended by the plan or coverage in each 

16 such plan year. 

17 ‘‘(7) Total spending on health care services by 

18 such group health plan or health insurance coverage, 

19 broken down by— 

20 ‘‘(A) the type of costs, including— 

21 ‘‘(i) hospital costs; 

22 ‘‘(ii) health care provider and clinical 

23 service costs, for primary care and spe24 cialty care separately; 

25 ‘‘(iii) costs for prescription drugs; and 


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1 ‘‘(iv) other medical costs, including 

2 wellness services; and 

3 ‘‘(B) spending on prescription drugs by— 

4 ‘‘(i) the health plan or coverage; and 

5 ‘‘(ii) the participants and bene6 ficiaries. 

7 ‘‘(8) The average monthly premium— 

8 ‘‘(A) paid by employers on behalf of par9 ticipants and beneficiaries, as applicable; and 

10 ‘‘(B) paid by participants and bene11 ficiaries. 

12 ‘‘(9) Any impact on premiums by rebates, fees, 

13 and any other remuneration paid by drug manufac14 turers to the plan or coverage or its administrators 

15 or service providers, with respect to prescription 

16 drugs prescribed to participants and beneficiaries in 

17 the plan or coverage, including— 

18 ‘‘(A) the amounts so paid for each thera19 peutic class of drugs; and 

20 ‘‘(B) the amounts so paid for each of the 

21 25 drugs that yielded the highest amount of re22 bates and other remuneration under the plan or 

23 coverage from drug manufacturers during the 

24 plan year. 


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1 ‘‘(10) Any reduction in premiums and out-of2 pocket costs associated with rebates, fees, or other 

3 remuneration described in paragraph (9). 

4 ‘‘(b) REPORT.—Not later than 18 months after the 

5 date on which the first report is required under subsection 

6 (a) and biannually thereafter, the Secretary, acting in co7 ordination with the Inspector General of the Department 

8 of Labor, shall make available on the internet website of 

9 the Department of Labor a report on prescription drug 

10 reimbursements under group health plans (or health in11 surance coverage offered in connection with such a plan), 

12 prescription drug pricing trends, and the role of prescrip13 tion drug costs in contributing to premium increases or 

14 decreases under such plans or coverage, aggregated in 

15 such a way as no drug or plan specific information will 

16 be made public. 

17 ‘‘(c) PRIVACY PROTECTIONS.—No confidential or 

18 trade secret information submitted to the Secretary under 

19 subsection (a) shall be included in the report under sub20 section (b).’’. 

21 (c) IRC.—Subchapter B of chapter 100 of the Inter22 nal Revenue Code of 1986 is amended by adding at the 

23 end the following: 


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1 ‘‘SEC. 9816. REPORTING ON PHARMACY BENEFITS AND 

2 DRUG COSTS. 

3 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

4 date of enactment of this section, and not later than 

5 March 1 of each year thereafter, a group health plan shall 

6 submit to the Secretary, the Secretary of Health and 

7 Human Services, and the Secretary of Labor the following 

8 information with respect to the health plan in the previous 

9 plan year: 

10 ‘‘(1) The beginning and end dates of the plan 

11 year. 

12 ‘‘(2) The number of participants and bene13 ficiaries. 

14 ‘‘(3) Each State in which the plan is offered. 

15 ‘‘(4) The 50 brand prescription drugs most fre16 quently dispensed by pharmacies for claims paid by 

17 the plan, and the total number of paid claims for 

18 each such drug. 

19 ‘‘(5) The 50 most costly prescription drugs with 

20 respect to the plan by total annual spending, and the 

21 annual amount spent by the plan for each such 

22 drug. 

23 ‘‘(6) The 50 prescription drugs with the great24 est increase in plan expenditures over the plan year 

25 preceding the plan year that is the subject of the re26 port, and, for each such drug, the change in 


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1 amounts expended by the plan in each such plan 

2 year. 

3 ‘‘(7) Total spending on health care services by 

4 such group health plan, broken down by— 

5 ‘‘(A) the type of costs, including— 

6 ‘‘(i) hospital costs; 

7 ‘‘(ii) health care provider and clinical 

8 service costs, for primary care and spe9 cialty care separately; 

10 ‘‘(iii) costs for prescription drugs; and 

11 ‘‘(iv) other medical costs, including 

12 wellness services; and 

13 ‘‘(B) spending on prescription drugs by— 

14 ‘‘(i) the health plan; and 

15 ‘‘(ii) the participants and bene16 ficiaries. 

17 ‘‘(8) The average monthly premium— 

18 ‘‘(A) paid by employers on behalf of par19 ticipants and beneficiaries, as applicable; and 

20 ‘‘(B) paid by participants and bene21 ficiaries. 

22 ‘‘(9) Any impact on premiums by rebates, fees, 

23 and any other remuneration paid by drug manufac24 turers to the plan or its administrators or service 

25 providers, with respect to prescription drugs preVerDate Sep 11 2014 23:07 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4959.IS S4959

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1 scribed to participants or beneficiaries in the plan, 

2 including— 

3 ‘‘(A) the amounts so paid for each thera4 peutic class of drugs; and 

5 ‘‘(B) the amounts so paid for each of the 

6 25 drugs that yielded the highest amount of re7 bates and other remuneration under the plan 

8 from drug manufacturers during the plan year. 

9 ‘‘(10) Any reduction in premiums and out-of10 pocket costs associated with rebates, fees, or other 

11 remuneration described in paragraph (9). 

12 ‘‘(b) REPORT.—Not later than 18 months after the 

13 date on which the first report is required under subsection 

14 (a) and biannually thereafter, the Secretary, acting in co15 ordination with the Inspector General of the Department 

16 of the Treasury, shall make available on the internet 

17 website of the Department of the Treasury a report on 

18 prescription drug reimbursements under group health 

19 plans, prescription drug pricing trends, and the role of 

20 prescription drug costs in contributing to premium in21 creases or decreases under such plans, aggregated in such 

22 a way as no drug or plan specific information will be made 

23 public. 

24 ‘‘(c) PRIVACY PROTECTIONS.—No confidential or 

25 trade secret information submitted to the Secretary under 


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1 subsection (a) shall be included in the report under sub2 section (b).’’. 

3 (d) CLERICAL AMENDMENTS.— 

4 (1) ERISA.—The table of contents in section 1 

5 of the Employee Retirement Income Security Act of 

6 1974 (29 U.S.C. 1001 et seq.) is amended by insert7 ing after the item relating to section 714 the fol8 lowing new items: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Reporting on pharmacy benefits and drug costs.’’. 

9 (2) IRC.—The table of sections for subchapter 

10 B of chapter 100 of the Internal Revenue Code of 

11 1986 is amended by adding at the end the following 

12 new item: 

‘‘Sec. 9816. Reporting on pharmacy benefits and drug costs.’’. 

Æ 


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