Patient Right to Know Drug Prices Act

To ensure that health insurance issuers and group health plans do not prohibit pharmacy providers from providing certain information to enrollees. 1. Short title This Act may be cited as the Patient Right to Know Drug Prices Act 2. Prohibition on limiting certain information on drug prices (a) Exchange plans Section 1311(e) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(e) (4) Information on prescription drugs The Exchange shall require health plans seeking certification as qualified health plans to ensure that— (A) the health insurance issuer does not restrict any pharmacy that dispenses a prescription drug to an enrollee in the plan from informing (or penalize such pharmacy for informing) an enrollee of any differential between the price of the drug to the enrollee under the plan and the price the individual would pay for the drug if the enrollee obtained the drug without using any health insurance coverage; and (B) any entity that provides pharmacy benefits management services under a contract with any such health plan does not, with respect to such plan or any health benefits plan that the entity contracts with to provide pharmacy benefits management services and that is offered by an entity other than such sponsor or organization, restrict a pharmacy that dispenses a prescription drug from informing (or penalize such pharmacy for informing) an enrollee of any differential between the price of the drug to the enrollee under the plan and the price the individual would pay for the drug if the enrollee obtained the drug without using any health insurance coverage. . (b) Other health plans The provisions of section 1311(e)(4) of the Patient Protection and Affordable Care Act (as added by subsection (a)) shall apply to all health insurance issuers with respect to health insurance coverage and to all group health plans (as such terms are defined in section 2791 of the Public Health Service Act ( 42 U.S.C. 300gg–91

Summary: Patient Right to Know Drug Prices Act (Sec. 2) This bill amends the Public Health Service Act to prohibit a health insurance plan or pharmacy benefits manager from restricting a pharmacy from informing an enrollee of any difference between the out-of-pocket cost of a drug under the plan and the cost of the drug without health insurance coverage. (Such restrictions are commonly referred to as gag clauses.) (Sec. 3) The bill also amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to apply certain antitrust filing requirements for generic drug applicants to biosimilar biological product applicants. (Biosimilar biological products, commonly referred to as biosimilars, are biological products approved by the Food and Drug Administration based on their similarity to an already-approved biological product.) Under current law, generic drug applicants that make agreements with brand name drug companies or other generic drug applicants regarding the manufacture, marketing, or sale of their drugs must file such agreements with the Federal Trade Commission and the Department of Justice. The bill subjects biosimilar biological product applicants to the same filing requirements.