Transparent Drug Pricing Act of 2019

To address the high cost of prescription drugs. 1. Short title This Act may be cited as the Transparent Drug Pricing Act of 2019 2. Price transparency at pharmacies Section 1927(g)(2) of the Social Security Act ( 42 U.S.C. 1396r–8(g)(2) (E) Disclosure of drug prices at point of sale Beginning January 1, 2022, as part of a State's drug use review program, applicable State law shall require pharmacists to disclose to customers, at the point of sale of any prescription drug— (i) the customer's out-of-pocket cost with respect to acquisition of such drug under the health plan in which the customer is enrolled, if applicable; and (ii) the cost to the consumer for acquisition of the drug without using any health plan. . 3. Requirements with respect to prescription drug cost-sharing Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 2729A. Requirements with respect to prescription drug cost-sharing (a) Credit towards deductible With respect to any enrollee in a health plan or individual or group health insurance coverage who pays out-of-pocket for the full cost of a prescription drug, the group health plan or health insurance issuer offering such health insurance coverage shall credit the full amount such enrollee paid for such drug towards any deductible under the plan or coverage applicable to prescription drugs. (b) Establishment of co-Payments for certain prescription drugs (1) In general A group health plan or a health insurance issuer offering group or individual health insurance coverage shall, not later than 60 days before the first annual open enrollment period after the date of enactment of the Transparent Drug Pricing Act of 2019 (2) Prohibition on changes in co-payment amounts A group health plan or health insurance issuer described in paragraph (1) may not change the co-payment amount published in accordance with paragraph (1) until the next plan year. (3) Calculation of out-of-pocket costs A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide a mechanism that enables enrollees in the plan or coverage to determine the projected total out-of-pocket costs of an enrollee in the plan or coverage for each prescription drug covered under such plan or coverage. . 4. International retail list price index (a) In general The retail list price in the United States for a drug approved under subsection (c) or (j) of section 505 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 42 U.S.C. 262 (b) Sunset The requirement under subsection (a) shall terminate on the date that is 5 years after the date of enactment of this Act.

Summary: Transparent Drug Pricing Act of 2019 This bill establishes several requirements relating to the prices of prescription drugs. For example, state Medicaid drug-use review programs must require pharmacists to disclose an individual's out-of-pocket cost for a prescription drug, and the price without health insurance, at the point-of-sale. Additionally, health insurers must publish the co-payment amount for each covered prescription drug prior to the annual open-enrollment period. The bill also temporarily prohibits the retail list price of drugs and biologics from exceeding the lowest retail list price among Canada, France, the United Kingdom, Japan, or Germany.