Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019

To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. 1. Short title This Act may be cited as the Creating Transparency to Have Drug Rebates Unlocked (C–THRU) Act of 2019 2. Public disclosure of drug discounts (a) In general Section 1150A of the Social Security Act ( 42 U.S.C. 1320b–23 (1) in subsection (c), in the matter preceding paragraph (1), by striking this section subsection (b)(1) (2) by adding at the end the following new subsection: (e) Public availability of certain information In order to allow patients and employers to compare PBMs’ ability to negotiate rebates, discounts, and price concessions and the amount of such rebates, discounts, and price concessions that are passed through to plan sponsors, beginning January 1, 2020, the Secretary shall make available on the Internet website of the Department of Health and Human Services the information provided to the Secretary under paragraphs (2) and (3) of subsection (b) with respect to each PBM. The Secretary shall ensure that such information is displayed in a manner that prevents the disclosure of information on rebates, discounts, and price concessions with respect to an individual drug or an individual plan. . (b) Effective date The amendments made by subsection (a) shall take effect on January 1, 2020. 3. Minimum drug discounts required To be passed through to the plan sponsor (a) In general Section 1150A of the Social Security Act ( 42 U.S.C. 1320b–23 (1) in the heading, by inserting ; minimum drug discounts required to be passed through to the plan sponsor (2) by adding at the end the following new subsection: (f) Minimum drug discounts required To be passed through to the plan sponsor (1) Requirement Beginning January 1, 2022, a PBM that manages prescription drug coverage under a contract with a PDP sponsor or MA organization described in subsection (b)(1) or a qualified health benefits plan described in subsection (b)(2), shall, with respect to the plan sponsor of a health benefits plan, pass through to the plan sponsor a minimum percent (as established by the Secretary) of the aggregate amount of the rebates, discounts, or price concessions that the PBM negotiates that are attributable to patient utilization under the plan. (2) Establishment The Secretary shall establish the minimum percent described in paragraph (1) in such a manner as will ensure that patients receive the maximum benefit of rebates, discounts, or price concessions while taking into account the costs of negotiating such rebates, discounts, and price concessions. (3) Enforcement A PDP sponsor of a prescription drug plan or an MA organization offering an MA–PD plan under part D of title XVIII may not contract with a PBM that is not in compliance with the requirement under paragraph (1). . (b) Effective date The amendments made by subsection (a) shall take effect on January 1, 2022. 4. Part D negotiated prices required to take into account all price concessions at the point-of-sale (a) In general Section 1860D–2(d)(1)(B) of the Social Security Act ( 42 U.S.C. 1395w–102(d)(1)(B) (1) by striking prices prices (i) In general For purposes ; and (2) by adding at the end the following new clause: (ii) Negotiated prices at point-of-sale (I) In general Negotiated prices for covered part D drugs described in clause (i), including all price negotiated concessions, shall be provided at the point-of-sale of the covered part D drug. If the negotiated price, including all negotiated price concessions, is not possible to calculate at the point-of-sale, an approximate negotiated price (as established by the Secretary) shall be used under the prescription drug plan or MA–PD plan. (II) Approximate negotiated price In determining an approximate negotiated price for a covered part D drug under subclause (I), the Secretary shall ensure that— (aa) such price reflects the estimated negotiated price that is based on the previous year’s negotiated price concessions negotiated under the plan for all or similar covered part D drugs or is based on such other factors as the Secretary may determine appropriate; and (bb) the use of such price does not prevent the use of value-based contracts between drug manufacturers, PDP sponsors, MA organizations, and pharmacies. . (b) Effective date The amendments made by subsection (a) shall apply to plan years beginning on or after January 1, 2021.

Summary: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019 This bill establishes a series of requirements relating to drug rebates and discounts under Medicare and Medicare Advantage (MA). Specifically, for each pharmacy benefits manager (PBM) that contracts with a prescription drug plan (PDP) under Medicare or MA, or with a qualified health benefits plan offered through a health insurance exchange, HHS must publish on its website (1) the amount and type of rebates and discounts negotiated by the PBM and the extent to which these rebates and discounts are passed on to the plan sponsor, and (2) the difference between the amount paid by the plan sponsor to the PBM and the amount paid by the PBM to pharmacies. As a condition of participation as a contractor under Medicare or MA, a PBM must pass on to a PDP sponsor a minimum percentage, as established by HHS, of the amount of rebates and discounts negotiated by the PBM that are attributable to patient utilization under the plan. The bill also modifies requirements regarding Medicare enrollees' access to negotiated drug prices. Current law requires a PDP sponsor to provide enrollees in Medicare or MA with access to negotiated drug prices that account for rebates and discounts. The bill requires that, with respect to a covered drug, a negotiated price (or, if necessary, an approximate negotiated price) be provided at the point of sale.