II 

118TH CONGRESS 

1ST SESSION S. 1374 

To prohibit group health plans and health insurance issuers from entering 

into contracts that would prevent or restrict patient access to drug 

pricing information otherwise available through consumer decision-support tools. 

IN THE SENATE OF THE UNITED STATES 

APRIL 27, 2023 

Mr. MARSHALL (for himself, Mr. MARKEY, Mr. GRASSLEY, and Mr. KAINE) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

A BILL 

To prohibit group health plans and health insurance issuers 

from entering into contracts that would prevent or restrict patient access to drug pricing information otherwise available through consumer decision-support tools. 

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 ‘‘Patient Right to Shop 

5 Act’’. 


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1 SEC. 2. PROHIBITION ON BLOCKING CONSUMER DECISION2 SUPPORT TOOLS. 

3 (a) PHSA.—Part D of title XXVII of the Public 

4 Health Service Act (42 U.S.C. 300gg–111 et seq.) is 

5 amended by adding at the end the following: 

6 ‘‘SEC. 2799A–11. PROHIBITION ON BLOCKING CONSUMER 

7 DECISION-SUPPORT TOOLS. 

8 ‘‘(a) IN GENERAL.—A group health plan or a health 

9 insurance issuer offering group or individual health insur10 ance coverage shall not enter into a contract with an entity 

11 that provides pharmacy benefit management services with 

12 respect to such plan or coverage if such contract— 

13 ‘‘(1) includes any terms, conditions, or costs 

14 that would prevent or restrict a third party who is 

15 in contract with the plan or issuer to provide a con16 sumer decision-support tool from using relevant in17 formation regarding prescription drug benefits under 

18 the plan or coverage that are administered by the 

19 entity providing pharmacy benefit management serv20 ices in contract with the plan or issuer; or 

21 ‘‘(2) fails to clearly state that the entity pro22 viding pharmacy benefit management services is re23 quired to provide data required under paragraph (1) 

24 in machine readable format for the operability, im25 plementation, and utilization of any such consumer 

26 decision-support tool at no cost (direct or indirect) 


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•S 1374 IS

1 to the group health plan, health insurance issuer, or 

2 the third party providing such consumer decision 

3 support. 

4 ‘‘(b) CONSUMER DECISION-SUPPORT TOOL.—In this 

5 section, the term ‘consumer decision-support tool’ means 

6 a tool designed to inform enrollees in a group health plan 

7 or health insurance coverage about all costs for prescrip8 tion drugs covered by the plan or coverage, including out9 of-pocket, copayment, and coinsurance responsibility, as 

10 well as additional savings opportunities through other 

11 channels such as manufacturer copayment assistance, 

12 cash price, and mail order pharmacy benefits.’’. 

13 (b) ERISA.— 

14 (1) IN GENERAL.—Subpart B of part 7 of sub15 title B of title I of the Employee Retirement Income 

16 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

17 amended by adding at the end the following: 

18 ‘‘SEC. 726. PROHIBITION ON BLOCKING CONSUMER DECI19 SION-SUPPORT TOOLS. 

20 ‘‘(a) IN GENERAL.—A group health plan or a health 

21 insurance issuer offering group health insurance coverage 

22 shall not enter into a contract with an entity that provides 

23 pharmacy benefit management services with respect to 

24 such plan or coverage if such contract— 


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1 ‘‘(1) includes any terms, conditions, or costs 

2 that would prevent or restrict a third party who is 

3 in contract with the plan or issuer to provide a con4 sumer decision-support tool from using relevant in5 formation regarding prescription drug benefits under 

6 the plan or coverage that are administered by the 

7 entity providing pharmacy benefit management serv8 ices in contract with the plan or issuer; or 

9 ‘‘(2) fails to clearly state that the entity pro10 viding pharmacy benefit management services is re11 quired to provide data required under paragraph (1) 

12 in machine readable format for the operability, im13 plementation, and utilization of any such consumer 

14 decision-support tool at no cost (direct or indirect) 

15 to the group health plan, health insurance issuer, or 

16 the third party providing such consumer decision 

17 support. 

18 ‘‘(b) CONSUMER DECISION-SUPPORT TOOL.—In this 

19 section, the term ‘consumer decision-support tool’ means 

20 a tool designed to inform participants and beneficiaries in 

21 a group health plan or health insurance coverage about 

22 all costs for prescription drugs covered by the plan or cov23 erage, including out-of-pocket, copayment, and coinsur24 ance responsibility, as well as additional savings opportu25 nities through other channels such as manufacturer copayVerDate Sep 11 2014 03:58 May 06, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1374.IS S1374

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1 ment assistance, cash price, and mail order pharmacy ben2 efits.’’. 

3 (2) CLERICAL AMENDMENT.—The table of con4 tents in section 1 of the Employee Retirement In5 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

6 is amended by inserting after the item relating to 

7 section 725 the following: 

‘‘Sec. 726. Prohibition on blocking consumer decision-support tools.’’. 

8 (c) INTERNAL REVENUE CODE.— 

9 (1) IN GENERAL.—Subchapter B of chapter 

10 100 of the Internal Revenue Code of 1986 is amend11 ed by adding at the end the following new section: 

12 ‘‘SEC. 9826. PROHIBITION ON BLOCKING CONSUMER DECI13 SION-SUPPORT TOOLS. 

14 ‘‘(a) IN GENERAL.—A group health plan offering 

15 group health insurance coverage shall not enter into a con16 tract with an entity that provides pharmacy benefit man17 agement services with respect to such plan if such con18 tract— 

19 ‘‘(1) includes any terms, conditions, or costs 

20 that would prevent or restrict a third party who is 

21 in contract with the plan to provide a consumer deci22 sion-support tool from using relevant information re23 garding prescription drug benefits under the plan 

24 that are administered by the entity providing pharVerDate Sep 11 2014 03:58 May 06, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1374.IS S1374

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1 macy benefit management services in contract with 

2 the plan; or 

3 ‘‘(2) fails to clearly state that the entity pro4 viding pharmacy benefit management services is re5 quired to provide data required under paragraph (1) 

6 in machine readable format for the operability, im7 plementation, and utilization of any such consumer 

8 decision-support tool at no cost (direct or indirect) 

9 to the group health plan or the third party providing 

10 such consumer decision support. 

11 ‘‘(b) CONSUMER DECISION-SUPPORT TOOL.—In this 

12 section, the term ‘consumer decision-support tool’ means 

13 a tool designed to inform participants and beneficiaries in 

14 a group health plan about all costs for prescription drugs 

15 covered by the plan, including out-of-pocket, copayment, 

16 and coinsurance responsibility, as well as additional sav17 ings opportunities through other channels such as manu18 facturer copayment assistance, cash price, and mail order 

19 pharmacy benefits.’’. 

20 (2) CLERICAL AMENDMENT.—The table of sec21 tions for subchapter B of chapter 100 of such Code 

22 is amended by adding at the end the following new 

23 item: 

‘‘Sec. 9826. Prohibition on blocking consumer decision-support tools.’’. 

24 (d) APPLICATION.—The amendments made by sub25 sections (a), (b), and (c) shall apply with respect to plan 


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1 years beginning on or after the date that is 2 years after 

2 the date of enactment of this Act. 

3 (e) REGULATIONS.—The Secretary of Health and 

4 Human Services, the Secretary of Labor, and the Sec5 retary of the Treasury shall jointly promulgate regulations 

6 to carry out the amendments made by subsections (a), (b), 

7 and (c), and shall issue draft regulations not later than 

8 1 year after the date of enactment of this Act. 

Æ 


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