Patient Right to Shop Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1374 Introduced in Senate (IS)]

&lt;DOC&gt;






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.

    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 ``Patient Right to Shop Act''.

SEC. 2. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.

    (a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following:

``SEC. 2799A-11. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT 
              TOOLS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage shall not enter 
into a contract with an entity that provides pharmacy benefit 
management services with respect to such plan or coverage if such 
contract--
            ``(1) includes any terms, conditions, or costs that would 
        prevent or restrict a third party who is in contract with the 
        plan or issuer to provide a consumer decision-support tool from 
        using relevant information regarding prescription drug benefits 
        under the plan or coverage that are administered by the entity 
        providing pharmacy benefit management services in contract with 
        the plan or issuer; or
            ``(2) fails to clearly state that the entity providing 
        pharmacy benefit management services is required to provide 
        data required under paragraph (1) in machine readable format 
        for the operability, implementation, and utilization of any 
        such consumer decision-support tool at no cost (direct or 
        indirect) to the group health plan, health insurance issuer, or 
        the third party providing such consumer decision support.
    ``(b) Consumer Decision-Support Tool.--In this section, the term 
`consumer decision-support tool' means a tool designed to inform 
enrollees in a group health plan or health insurance coverage about all 
costs for prescription drugs covered by the plan or coverage, including 
out-of-pocket, copayment, and coinsurance responsibility, as well as 
additional savings opportunities through other channels such as 
manufacturer copayment assistance, cash price, and mail order pharmacy 
benefits.''.
    (b) ERISA.--
            (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. 726. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group health insurance coverage shall not enter into a 
contract with an entity that provides pharmacy benefit management 
services with respect to such plan or coverage if such contract--
            ``(1) includes any terms, conditions, or costs that would 
        prevent or restrict a third party who is in contract with the 
        plan or issuer to provide a consumer decision-support tool from 
        using relevant information regarding prescription drug benefits 
        under the plan or coverage that are administered by the entity 
        providing pharmacy benefit management services in contract with 
        the plan or issuer; or
            ``(2) fails to clearly state that the entity providing 
        pharmacy benefit management services is required to provide 
        data required under paragraph (1) in machine readable format 
        for the operability, implementation, and utilization of any 
        such consumer decision-support tool at no cost (direct or 
        indirect) to the group health plan, health insurance issuer, or 
        the third party providing such consumer decision support.
    ``(b) Consumer Decision-Support Tool.--In this section, the term 
`consumer decision-support tool' means a tool designed to inform 
participants and beneficiaries in a group health plan or health 
insurance coverage about all costs for prescription drugs covered by 
the plan or coverage, including out-of-pocket, copayment, and 
coinsurance responsibility, as well as additional savings opportunities 
through other channels such as manufacturer copayment assistance, cash 
price, and mail order pharmacy benefits.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1001 et seq.) is amended by inserting after the item 
        relating to section 725 the following:

``Sec. 726. Prohibition on blocking consumer decision-support tools.''.
    (c) Internal Revenue Code.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9826. PROHIBITION ON BLOCKING CONSUMER DECISION-SUPPORT TOOLS.

    ``(a) In General.--A group health plan offering group health 
insurance coverage shall not enter into a contract with an entity that 
provides pharmacy benefit management services with respect to such plan 
if such contract--
            ``(1) includes any terms, conditions, or costs that would 
        prevent or restrict a third party who is in contract with the 
        plan to provide a consumer decision-support tool from using 
        relevant information regarding prescription drug benefits under 
        the plan that are administered by the entity providing pharmacy 
        benefit management services in contract with the plan; or
            ``(2) fails to clearly state that the entity providing 
        pharmacy benefit management services is required to provide 
        data required under paragraph (1) in machine readable format 
        for the operability, implementation, and utilization of any 
        such consumer decision-support tool at no cost (direct or 
        indirect) to the group health plan or the third party providing 
        such consumer decision support.
    ``(b) Consumer Decision-Support Tool.--In this section, the term 
`consumer decision-support tool' means a tool designed to inform 
participants and beneficiaries in a group health plan about all costs 
for prescription drugs covered by the plan, including out-of-pocket, 
copayment, and coinsurance responsibility, as well as additional 
savings opportunities through other channels such as manufacturer 
copayment assistance, cash price, and mail order pharmacy benefits.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of such Code is amended by adding 
        at the end the following new item:

``Sec. 9826. Prohibition on blocking consumer decision-support 
                            tools.''.
    (d) Application.--The amendments made by subsections (a), (b), and 
(c) shall apply with respect to plan years beginning on or after the 
date that is 2 years after the date of enactment of this Act.
    (e) Regulations.--The Secretary of Health and Human Services, the 
Secretary of Labor, and the Secretary of the Treasury shall jointly 
promulgate regulations to carry out the amendments made by subsections 
(a), (b), and (c), and shall issue draft regulations not later than 1 
year after the date of enactment of this Act.
                                 &lt;all&gt;
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