242 
States, State Medicaid plans under title XIX, State 
child health plans under title XXI, Medicaid man-
aged care organizations, prepaid inpatient health 
plans, prepaid ambulatory health plans, and primary 
care case managers, including during national public 
health emergencies; and 
(4) strategies States can use to integrate tele-
health and other virtual health care services into 
value-based health care models. 
SEC. 506. REMOVAL OF LIMITATIONS ON FEDERAL FINAN-
CIAL PARTICIPATION FOR INMATES WHO ARE 
ELIGIBLE JUVENILES PENDING DISPOSITION 
OF CHARGES. 
(a) MEDICAID.— 
(1) IN GENERAL.—The subdivision (A) of sec-
tion 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) following paragraph (31) of such section, 
as amended by section 501(b), is further amended 
by inserting ‘‘, or, at the option of the State, for an 
individual who is an eligible juvenile (as defined in 
section 1902(nn)(2)), while such individual is an in-
mate of a public institution (as defined in section 
1902(nn)(3)) pending disposition of charges’’ after 
‘‘or in the case of an eligible juvenile described in 
section 
1902(a)(84)(D) 
with 
respect 
to 
the
243 
screenings, diagnostic services, referrals, and case 
management required under such subparagraph 
(D)’’. 
(2) CONFORMING.—Section 1902(a)(84)(A) of 
the Social Security Act (42 U.S.C. 1396a(a)(84)(A)) 
is amended by inserting ‘‘(or in the case of a State 
electing the option described in the subdivision (A) 
following paragraph (31) of section 1905(a), during 
such period beginning after the disposition of 
charges with respect to such individual)’’ after ‘‘is 
such an inmate’’. 
(b) CHIP.—Section 2110(b)(7) of the Social Security 
Act (42 U.S.C. 13977jj(b)(7)), as added by section 
501(c)(2)(B), is further amended by inserting ‘‘or, at the 
option of the State, for an individual who is a juvenile, 
while such individual is an inmate of a public institution 
pending disposition of charges’’ after ‘‘if such child is an 
eligible juvenile (as described in section 1902(a)(84)(D)) 
with respect to screenings, diagnostic services, referrals, 
and case management otherwise covered under the State 
child health plan (or waiver of such plan)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the first day of the first 
calendar quarter that begins after the date that is 18 
months after the date of enactment of this Act and shall
244 
apply to items and services furnished for periods beginning 
on or after such date. 
TITLE VI—MISCELLANEOUS 
PROVISIONS 
SEC. 601. DETERMINATION OF BUDGETARY EFFECTS. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 
Act, submitted for printing in the Congressional Record 
by the Chairman of the House Budget Committee, pro-
vided that such statement has been submitted prior to the 
vote on passage. 
SEC. 602. OVERSIGHT OF PHARMACY BENEFIT MANAGER 
SERVICES. 
(a) PHSA.—Title XXVII of the Public Health Serv-
ice Act (42 U.S.C. 300gg et seq.) is amended— 
(1) in part D (42 U.S.C. 300gg–111 et seq.), 
by adding at the end the following new section: 
‘‘SEC. 2799A–11. OVERSIGHT OF PHARMACY BENEFIT MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2024, a group health plan or health in-
surance issuer offering group health insurance coverage 
or an entity or subsidiary providing pharmacy benefits
245 
management services on behalf of such a plan or issuer 
shall not enter into a contract with a drug manufacturer, 
distributor, wholesaler, subcontractor, rebate aggregator, 
or any associated third party that limits the disclosure of 
information to plan sponsors in such a manner that pre-
vents the plan or issuer, or an entity or subsidiary pro-
viding pharmacy benefits management services on behalf 
of a plan or issuer, from making the reports described in 
subsection (b). 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2024, not less frequently 
than once every 6 months, a health insurance issuer 
offering group health insurance coverage or an enti-
ty providing pharmacy benefits management services 
on behalf of a group health plan or an issuer pro-
viding group health insurance coverage shall submit 
to the plan sponsor (as defined in section 3(16)(B) 
of the Employee Retirement Income Security Act of 
1974) of such group health plan or health insurance 
coverage a report in accordance with this subsection 
and make such report available to the plan sponsor 
in a machine-readable format. Each such report 
shall include, with respect to the applicable group 
health plan or health insurance coverage—
246 
‘‘(A) as applicable, information collected 
from drug manufacturers by such issuer or en-
tity on the total amount of copayment assist-
ance dollars paid, or copayment cards applied, 
that were funded by the drug manufacturer 
with respect to the participants and bene-
ficiaries in such plan or coverage; 
‘‘(B) a list of each drug covered by such 
plan, issuer, or entity providing pharmacy ben-
efit management services that was dispensed 
during the reporting period, including, with re-
spect to each such drug during the reporting 
period— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
‘‘(ii) the number of participants and 
beneficiaries for whom the drug was filled 
during the plan year, the total number of 
prescription fills for the drug (including 
original prescriptions and refills), and the 
total number of dosage units of the drug 
dispensed across the plan year, including 
whether the dispensing channel was by re-
tail, mail order, or specialty pharmacy;
247 
‘‘(iii) the wholesale acquisition cost, 
listed as cost per days supply and cost per 
pill, or in the case of a drug in another 
form, per dose; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; and 
‘‘(v) for any drug for which gross 
spending of the group health plan or 
health 
insurance 
coverage 
exceeded 
$10,000 during the reporting period— 
‘‘(I) a list of all other drugs in 
the same therapeutic category or 
class, including brand name drugs 
and biological products and generic 
drugs or biosimilar biological products 
that are in the same therapeutic cat-
egory or class as such drug; and 
‘‘(II) the rationale for preferred 
formulary placement of such drug in 
that therapeutic category or class, if 
applicable;
248 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
health plan or health insurance coverage during 
the reporting period, and, with respect to each 
such therapeutic category or class of drugs, 
during the reporting period— 
‘‘(i) total gross spending by the plan, 
before manufacturer rebates, fees, or other 
manufacturer remuneration; 
‘‘(ii) the number of participants and 
beneficiaries who filled a prescription for a 
drug in that category or class; 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
and utilization mechanisms (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries, including 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; and 
‘‘(v) for each therapeutic category or 
class under which 3 or more drugs are in-
249 
cluded on the formulary of such plan or 
coverage— 
‘‘(I) the amount received, or ex-
pected to be received, from drug man-
ufacturers in rebates, fees, alternative 
discounts, or other remuneration— 
‘‘(aa) that has been paid, or 
is to be paid, by drug manufac-
turers for claims incurred during 
the reporting period; or 
‘‘(bb) that is related to utili-
zation of drugs, in such thera-
peutic category or class; 
‘‘(II) the total net spending, after 
deducting rebates, price concessions, 
alternative discounts or other remu-
neration from drug manufacturers, by 
the health plan or health insurance 
coverage on that category or class of 
drugs; and 
‘‘(III) the net price per course of 
treatment or single fill, such as a 30- 
day supply or 90-day supply, incurred 
by the health plan or health insurance 
coverage and its participants and
250 
beneficiaries, after manufacturer re-
bates, fees, and other remuneration 
for drugs dispensed within such thera-
peutic category or class during the re-
porting period; 
‘‘(D) total gross spending on prescription 
drugs by the plan or coverage during the re-
porting period, before rebates and other manu-
facturer fees or remuneration; 
‘‘(E) total amount received, or expected to 
be received, by the health plan or health insur-
ance coverage in drug manufacturer rebates, 
fees, alternative discounts, and all other remu-
neration received from the manufacturer or any 
third party, other than the plan sponsor, re-
lated to utilization of drug or drug spending 
under that health plan or health insurance cov-
erage during the reporting period; 
‘‘(F) the total net spending on prescription 
drugs by the health plan or health insurance 
coverage during the reporting period; and 
‘‘(G) amounts paid directly or indirectly in 
rebates, fees, or any other type of remuneration 
to brokers, consultants, advisors, or any other 
individual or firm who referred the group health
251 
plan’s or health insurance issuer’s business to 
the pharmacy benefit manager. 
‘‘(2) PRIVACY REQUIREMENTS.—Health insur-
ance issuers offering group health insurance cov-
erage and entities providing pharmacy benefits man-
agement services on behalf of a group health plan 
shall provide information under paragraph (1) in a 
manner consistent with the privacy, security, and 
breach notification regulations promulgated under 
section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, and shall restrict 
the use and disclosure of such information according 
to such privacy regulations. 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
‘‘(B) CLARIFICATION REGARDING PUBLIC 
DISCLOSURE
OF
INFORMATION.—Nothing in 
this section prevents a health insurance issuer 
offering group health insurance coverage or an 
entity providing pharmacy benefits management
252 
services on behalf of a group health plan from 
placing reasonable restrictions on the public dis-
closure of the information contained in a report 
described in paragraph (1), except that such 
issuer or entity may not restrict disclosure of 
such report to the Department of Health and 
Human Services, the Department of Labor, the 
Department of the Treasury, or applicable 
State agencies. 
‘‘(C) LIMITED
FORM
OF
REPORT.—The 
Secretary shall define through rulemaking a 
limited form of the report under paragraph (1) 
required of plan sponsors who are drug manu-
facturers, drug wholesalers, or other direct par-
ticipants in the drug supply chain, in order to 
prevent anti-competitive behavior. 
‘‘(4) REPORT
TO
GAO.—A health insurance 
issuer offering group health insurance coverage or 
an entity providing pharmacy benefits management 
services on behalf of a group health plan shall sub-
mit to the Comptroller General of the United States 
each of the first 4 reports submitted to a plan spon-
sor under paragraph (1) with respect to such cov-
erage or plan, and other such reports as requested, 
in accordance with the privacy requirements under
253 
paragraph (2), the disclosure and redisclosure stand-
ards under paragraph (3), the standards specified 
pursuant to paragraph (5), and such other informa-
tion that the Comptroller General determines nec-
essary to carry out the study under section 602(d) 
of the Restoring Hope for Mental Health and Well- 
Being Act of 2022. 
‘‘(5) STANDARD FORMAT.—Not later than June 
1, 2023, the Secretary shall specify through rule-
making standards for health insurance issuers and 
entities required to submit reports under paragraph 
(4) to submit such reports in a standard format. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of the Treasury, shall enforce this section. 
‘‘(2) FAILURE TO PROVIDE TIMELY INFORMA-
TION.—A health insurance issuer or an entity pro-
viding pharmacy benefit management services that 
violates subsection (a) or fails to provide information 
required under subsection (b), or a drug manufac-
turer that fails to provide information under sub-
section (b)(1)(A) in a timely manner, shall be sub-
ject to a civil monetary penalty in the amount of 
$10,000 for each day during which such violation
254 
continues or such information is not disclosed or re-
ported. 
‘‘(3) FALSE INFORMATION.—A health insurance 
issuer, entity providing pharmacy benefit manage-
ment services, or drug manufacturer that knowingly 
provides false information under this section shall be 
subject to a civil money penalty in an amount not 
to exceed $100,000 for each item of false informa-
tion. Such civil money penalty shall be in addition to 
other penalties as may be prescribed by law. 
‘‘(4) PROCEDURE.—The provisions of section 
1128A of the Social Security Act, other than sub-
section (a) and (b) and the first sentence of sub-
section (c)(1) of such section shall apply to civil 
monetary penalties under this subsection in the 
same manner as such provisions apply to a penalty 
or proceeding under section 1128A of the Social Se-
curity Act. 
‘‘(5) WAIVERS.—The Secretary may waive pen-
alties under paragraph (2), or extend the period of 
time for compliance with a requirement of this sec-
tion, for an entity in violation of this section that 
has made a good-faith effort to comply with this sec-
tion.
255 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit a health insurance issuer, 
group health plan, or other entity to restrict disclosure to, 
or otherwise limit the access of, the Department of Health 
and Human Services to a report described in subsection 
(b)(1) or information related to compliance with sub-
section (a) by such issuer, plan, or entity. 
‘‘(e) DEFINITION.—In this section, the term ‘whole-
sale acquisition cost’ has the meaning given such term in 
section 1847A(c)(6)(B) of the Social Security Act.’’; and 
(2) in section 2723 (42 U.S.C. 300gg–22)— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–11)’’ after ‘‘part D’’; and 
(ii) in paragraph (2), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–11)’’ after ‘‘part D’’; and 
(B) in subsection (b)— 
(i) in paragraph (1), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–11)’’ after ‘‘part D’’; 
(ii) in paragraph (2)(A), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–11)’’ after ‘‘part D’’; and
256 
(iii) in paragraph (2)(C)(ii), by insert-
ing ‘‘(other than subsections (a) and (b) of 
section 2799A–11)’’ after ‘‘part D’’. 
(b) ERISA.— 
(1) IN GENERAL.—Subtitle B of title I of the 
Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1021 et seq.) is amended— 
(A) in subpart B of part 7 (29 U.S.C. 
1185 et seq.), by adding at the end the fol-
lowing: 
‘‘SEC. 726. OVERSIGHT OF PHARMACY BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2024, a group health plan (or health in-
surance issuer offering group health insurance coverage 
in connection with such a plan) or an entity or subsidiary 
providing pharmacy benefits management services on be-
half of such a plan or issuer shall not enter into a contract 
with a drug manufacturer, distributor, wholesaler, subcon-
tractor, rebate aggregator, or any associated third party 
that limits the disclosure of information to plan sponsors 
in such a manner that prevents the plan or issuer, or an 
entity or subsidiary providing pharmacy benefits manage-
ment services on behalf of a plan or issuer, from making 
the reports described in subsection (b).
257 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2024, not less frequently 
than once every 6 months, a health insurance issuer 
offering group health insurance coverage or an enti-
ty providing pharmacy benefits management services 
on behalf of a group health plan or an issuer pro-
viding group health insurance coverage shall submit 
to the plan sponsor (as defined in section 3(16)(B)) 
of such group health plan or group health insurance 
coverage a report in accordance with this subsection 
and make such report available to the plan sponsor 
in a machine-readable format. Each such report 
shall include, with respect to the applicable group 
health plan or health insurance coverage— 
‘‘(A) as applicable, information collected 
from drug manufacturers by such issuer or en-
tity on the total amount of copayment assist-
ance dollars paid, or copayment cards applied, 
that were funded by the drug manufacturer 
with respect to the participants and bene-
ficiaries in such plan or coverage; 
‘‘(B) a list of each drug covered by such 
plan, issuer, or entity providing pharmacy ben-
efit management services that was dispensed
258 
during the reporting period, including, with re-
spect to each such drug during the reporting 
period— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
‘‘(ii) the number of participants and 
beneficiaries for whom the drug was filled 
during the plan year, the total number of 
prescription fills for the drug (including 
original prescriptions and refills), and the 
total number of dosage units of the drug 
dispensed across the plan year, including 
whether the dispensing channel was by re-
tail, mail order, or specialty pharmacy; 
‘‘(iii) the wholesale acquisition cost, 
listed as cost per days supply and cost per 
pill, or in the case of a drug in another 
form, per dose; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; and 
‘‘(v) for any drug for which gross 
spending of the group health plan or
259 
health 
insurance 
coverage 
exceeded 
$10,000 during the reporting period— 
‘‘(I) a list of all other drugs in 
the same therapeutic category or 
class, including brand name drugs 
and biological products and generic 
drugs or biosimilar biological products 
that are in the same therapeutic cat-
egory or class as such drug; and 
‘‘(II) the rationale for preferred 
formulary placement of such drug in 
that therapeutic category or class, if 
applicable; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
health plan or health insurance coverage during 
the reporting period, and, with respect to each 
such therapeutic category or class of drugs, 
during the reporting period— 
‘‘(i) total gross spending by the plan, 
before manufacturer rebates, fees, or other 
manufacturer remuneration; 
‘‘(ii) the number of participants and 
beneficiaries who filled a prescription for a 
drug in that category or class;
260 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
and utilization mechanisms (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries, including 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; and 
‘‘(v) for each therapeutic category or 
class under which 3 or more drugs are in-
cluded on the formulary of such plan or 
coverage— 
‘‘(I) the amount received, or ex-
pected to be received, from drug man-
ufacturers in rebates, fees, alternative 
discounts, or other remuneration— 
‘‘(aa) that has been paid, or 
is to be paid, by drug manufac-
turers for claims incurred during 
the reporting period; or 
‘‘(bb) that is related to utili-
zation of drugs, in such thera-
peutic category or class;
261 
‘‘(II) the total net spending, after 
deducting rebates, price concessions, 
alternative discounts or other remu-
neration from drug manufacturers, by 
the health plan or health insurance 
coverage on that category or class of 
drugs; and 
‘‘(III) the net price per course of 
treatment or single fill, such as a 30- 
day supply or 90-day supply, incurred 
by the health plan or health insurance 
coverage and its participants and 
beneficiaries, after manufacturer re-
bates, fees, and other remuneration 
for drugs dispensed within such thera-
peutic category or class during the re-
porting period; 
‘‘(D) total gross spending on prescription 
drugs by the plan or coverage during the re-
porting period, before rebates and other manu-
facturer fees or remuneration; 
‘‘(E) total amount received, or expected to 
be received, by the health plan or health insur-
ance coverage in drug manufacturer rebates, 
fees, alternative discounts, and all other remu-
262 
neration received from the manufacturer or any 
third party, other than the plan sponsor, re-
lated to utilization of drug or drug spending 
under that health plan or health insurance cov-
erage during the reporting period; 
‘‘(F) the total net spending on prescription 
drugs by the health plan or health insurance 
coverage during the reporting period; and 
‘‘(G) amounts paid directly or indirectly in 
rebates, fees, or any other type of remuneration 
to brokers, consultants, advisors, or any other 
individual or firm who referred the group health 
plan’s or health insurance issuer’s business to 
the pharmacy benefit manager. 
‘‘(2) PRIVACY REQUIREMENTS.—Health insur-
ance issuers offering group health insurance cov-
erage and entities providing pharmacy benefits man-
agement services on behalf of a group health plan 
shall provide information under paragraph (1) in a 
manner consistent with the privacy, security, and 
breach notification regulations promulgated under 
section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, and shall restrict 
the use and disclosure of such information according 
to such privacy regulations.
263 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
‘‘(B) CLARIFICATION REGARDING PUBLIC 
DISCLOSURE
OF
INFORMATION.—Nothing in 
this section prevents a health insurance issuer 
offering group health insurance coverage or an 
entity providing pharmacy benefits management 
services on behalf of a group health plan from 
placing reasonable restrictions on the public dis-
closure of the information contained in a report 
described in paragraph (1), except that such 
issuer or entity may not restrict disclosure of 
such report to the Department of Health and 
Human Services, the Department of Labor, the 
Department of the Treasury, or applicable 
State agencies. 
‘‘(C) LIMITED
FORM
OF
REPORT.—The 
Secretary shall define through rulemaking a 
limited form of the report under paragraph (1) 
required of plan sponsors who are drug manu-