such an amount paid to a provider that, during 
such period, submitted fewer than 20 claims for 
such drug to such plan or coverage. 
‘‘(C) With respect to each item or service 
for which benefits are available under such plan 
or coverage, the amount billed, and the amount 
allowed by the plan or coverage, for each such 
item or service furnished during the 90-day pe-
riod specified in subparagraph (B) by a pro-
vider that was not a participating provider with 
respect to such item or service, broken down by 
each such provider, other than items and serv-
ices with respect to which fewer than 20 claims 
for such item or service were submitted to such 
plan or coverage during such period. 
‘‘(3) MANNER
OF
PUBLICATION.—Rate and 
payment information required to be made available 
under this subsection shall be so made available in 
dollar amounts through 3 separate machine-readable 
files (or any successor technology, such as applica-
tion program interface technology, determined ap-
propriate by the Secretary) corresponding to the in-
formation described in each of subparagraphs (A) 
through (C) of paragraph (2) that meet such re-
quirements as specified by the Secretary. Such re-
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quirements shall ensure that such files are limited to 
an appropriate size, do not include disclosure of un-
necessary duplicative information contained in other 
files made available under this subsection, are made 
available in a widely-available format through a pub-
licly-available website that allows for information 
contained in such files to be compared across group 
health plans and group and individual health insur-
ance coverage, and are accessible to individuals at no 
cost and without the need to establish a user ac-
count or provide other credentials. 
‘‘(4) USER INSTRUCTIONS.—Each group health 
plan and group or individual health insurance cov-
erage shall make available to the public instructions 
written in plain language explaining how individuals 
may search for information described in paragraph 
(2) in files submitted in accordance with paragraph 
(3). The Secretary shall develop and publish a tem-
plate that such a plan or coverage may use in devel-
oping instructions for purposes of the preceding sen-
tence. 
‘‘(5) ATTESTATION.—Each group health plan 
and group or individual health insurance coverage 
shall post, along with rate and payment information 
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made public by such plan or coverage, an attestation 
that such information is complete and accurate. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) PARTICIPATING
PROVIDER.—The term 
‘participating provider’ has the meaning given such 
term in section 2791A–1(a)(3)(G)(ii). 
‘‘(2) IN-NETWORK
RATE.—The term ‘in-net-
work rate’ means, with respect to a health plan or 
coverage and an item or service furnished by a pro-
vider that is a participating provider with respect to 
such plan and item or service, the contracted rate in 
effect between such plan or coverage and such pro-
vider for such item or service.’’. 
(3) ERISA.— 
(A) IN GENERAL.—Section 719 of the Em-
ployee Retirement Income Security Act of 1974 
(29 U.S.C. 1185h) is amended to read as fol-
lows: 
‘‘SEC. 719. PRICE TRANSPARENCY REQUIREMENTS. 
‘‘(a) COST SHARING TRANSPARENCY.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after the date that is 2 years after the date 
of the enactment of the Health Care Price Trans-
parency Act of 2023, a group health plan or a 
health insurance issuer offering group health insur-
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ance coverage shall permit individuals to learn the 
amount of cost-sharing (including deductibles, co-
payments, and coinsurance) under the individual’s 
plan or coverage that the individual would be re-
sponsible for paying with respect to the furnishing 
of a specific item or service by a provider in a timely 
manner upon the request of the individual. At a 
minimum, such information shall include the infor-
mation specified in paragraph (2) and shall be made 
available to such individual through a self-service 
tool that meets the requirements of paragraph (3) 
or, at the option of such individual, through a paper 
disclosure or phone or other electronic disclosure (as 
selected by such individual and provided at no cost 
to such individual) that meets such requirements as 
the Secretary may specify. 
‘‘(2) SPECIFIED INFORMATION.—For purposes 
of paragraph (1), the information specified in this 
paragraph is, with respect to an item or service for 
which benefits are available under a group health 
plan or group health insurance coverage furnished 
by a health care provider to a participant or bene-
ficiary of such plan, or enrollee in such coverage, the 
following: 
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‘‘(A) If such provider is a participating 
provider with respect to such item or service, 
the in-network rate (as defined in subsection 
(c)) for such item or service. 
‘‘(B) If such provider is not described in 
subparagraph 
(A), 
the 
maximum 
allowed 
amount for such item or service. 
‘‘(C) The estimated amount of cost sharing 
(including deductibles, copayments, and coin-
surance) that the participant or beneficiary will 
incur for such item or service (which, in the 
case such item or service is to be furnished by 
a provider described in subparagraph (B), shall 
be calculated using the maximum amount de-
scribed in such subparagraph). 
‘‘(D) The amount the participant, bene-
ficiary, or enrollee has already accumulated 
with respect to any deductible or out of pocket 
maximum, whether for items and services fur-
nished by a participating provider or for items 
and services furnished by a provider that is not 
a participating provider, under the plan or cov-
erage (broken down, in the case separate 
deductibles or maximums apply to separate par-
ticipants, beneficiaries or enrollees enrolled in 
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the plan or coverage, by such separate 
deductibles or maximums, in addition to any 
cumulative deductible or maximum). 
‘‘(E) In the case such plan or coverage im-
poses any frequency or volume limitations with 
respect to such item or service (excluding med-
ical necessity determinations), the amount that 
such participant, beneficiary, or enrollee has ac-
crued towards such limitation with respect to 
such item or service. 
‘‘(F) Any prior authorization, concurrent 
review, step therapy, fail first, or similar re-
quirements applicable to coverage of such item 
or service under such plan or coverage. 
The Secretary may provide that information de-
scribed in any of subparagraphs (A) through (F) not 
be treated as information specified in this para-
graph, and specify additional information that shall 
be treated as information specified in this para-
graph, if determined appropriate by the Secretary. 
‘‘(3) SELF-SERVICE
TOOL.—For purposes of 
paragraph (1), a self-service tool established by a 
group health plan or group health insurance cov-
erage meets the requirements of this paragraph if 
such tool— 
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The Secretary may require such tool, as a condition 
of complying with subparagraph (E), to link multiple 
billing codes to a single descriptive term if the Sec-
retary determines that the billing codes to be so 
linked correspond to similar items and services. 
‘‘(b) RATE AND PAYMENT INFORMATION.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after the date that is 2 years after the date 
of the enactment of the Health Care Price Trans-
parency Act of 2023, each group health plan (other 
than a grandfathered health plan (as defined in sec-
tion 1251(e) of the Patient Protection and Afford-
able Care Act) or group health insurance coverage, 
shall, not less frequently than once every 3 months 
(or, in the case of information described in para-
graph (2)(B), not less frequently than monthly), 
make available to the public the rate and payment 
information described in paragraph (2) in accord-
ance with paragraph (3). 
‘‘(2) RATE
AND
PAYMENT
INFORMATION
DE-
SCRIBED.—For purposes of paragraph (1), the rate 
and payment information described in this para-
graph is, with respect to a group health plan or 
group health insurance coverage, the following: 
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‘‘(A) With respect to each item or service 
(other than a drug) for which benefits are avail-
able under such plan or coverage, the in-net-
work rate in effect with each provider that is a 
participating provider with respect to such item 
or service, other than such a rate in effect with 
a provider that, during the 1-year period ending 
10 business days before the date of the publica-
tion of such information, did not submit any 
claim for such item or service to such plan or 
coverage. 
‘‘(B) With respect to each drug (identified 
by national drug code) for which benefits are 
available under such plan, the average amount 
paid by such plan or coverage (net of rebates, 
discounts, and price concessions) for such drug 
dispensed or administered during the 90-day 
period beginning 180 days before such date of 
publication to each provider that was a partici-
pating provider with respect to such drug, bro-
ken down by each such provider, other than 
such an amount paid to a provider that, during 
such period, submitted fewer than 20 claims for 
such drug to such plan or coverage. 
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‘‘(C) With respect to each item or service 
for which benefits are available under such plan 
or coverage, the amount billed, and the amount 
allowed by the plan or coverage, for each such 
item or service furnished during the 90-day pe-
riod specified in subparagraph (B) by a pro-
vider that was not a participating provider with 
respect to such item or service, broken down by 
each such provider, other than items and serv-
ices with respect to which fewer than 20 claims 
for such item or service were submitted to such 
plan or coverage during such period. 
‘‘(3) MANNER
OF
PUBLICATION.—Rate and 
payment information required to be made available 
under this subsection shall be so made available in 
dollar amounts through 3 separate machine-readable 
files (or any successor technology, such as applica-
tion program interface technology, determined ap-
propriate by the Secretary) corresponding to the in-
formation described in each of subparagraphs (A) 
through (C) of paragraph (2) that meet such re-
quirements as specified by the Secretary. Such re-
quirements shall ensure that such files are limited to 
an appropriate size, do not include disclosure of un-
necessary duplicative information contained in other 
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files made available under this subsection, are made 
available in a widely-available format through a pub-
licly-available website that allows for information 
contained in such files to be compared across group 
health plans and group and individual health insur-
ance coverage, and are accessible to individuals at no 
cost and without the need to establish a user ac-
count or provide other credentials. 
‘‘(4) USER INSTRUCTIONS.—Each group health 
plan and group health insurance coverage shall make 
available to the public instructions written in plain 
language explaining how individuals may search for 
information described in paragraph (2) in files sub-
mitted in accordance with paragraph (3). The Sec-
retary shall develop and publish a template that 
such a plan or coverage may use in developing in-
structions for purposes of the preceding sentence. 
‘‘(5) ATTESTATION.—Each group health plan 
and group health insurance coverage shall post, 
along with rate and payment information made pub-
lic by such plan or coverage, an attestation that such 
information is complete and accurate. 
‘‘(c) DEFINITIONS.—In this section: 
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‘‘(1) PARTICIPATING
PROVIDER.—The term 
‘participating provider’ has the meaning given such 
term in section 716(a)(3)(G)(ii). 
‘‘(2) IN-NETWORK
RATE.—The term ‘in-net-
work rate’ means, with respect to a health plan or 
coverage and an item or service furnished by a pro-
vider that is a participating provider with respect to 
such plan and item or service, the contracted rate in 
effect between such plan or coverage and such pro-
vider for such item or service.’’. 
(B) CLERICAL AMENDMENT.—The table of 
contents in section 1 of the Employee Retire-
ment Income Security Act of 1974 is amended 
by striking the item relating to section 719 and 
inserting the following new item: 
‘‘Sec. 719. Price transparency requirements.’’. 
(b) ACCESSIBILITY THROUGH IMPLEMENTATION.— 
In implementing the amendments made by subsection (a), 
the Secretary of the Treasury, the Secretary of Health and 
Human Services, and the Secretary of Labor shall take 
reasonable steps to ensure the accessibility of information 
made available pursuant to such amendments, including 
reasonable steps to ensure that such information is pro-
vided in plain, easily understandable language and that 
interpretation, translations, and assistive services are pro-
vided by group health plans and health insurance issuers 
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offering group or individual health insurance coverage to 
make such information accessible to those with limited 
English proficiency and those with disabilities. 
(c) CONTINUED APPLICABILITY OF RULES FOR PRE-
VIOUS YEARS.—Nothing in the amendments made by sub-
section (a) may be construed as affecting the applicability 
of the rule entitled ‘‘Transparency in Coverage’’ published 
by the Department of the Treasury, the Department of 
Labor, and the Department of Health and Human Serv-
ices on November 12, 2020 (85 Fed. Reg. 72158) for any 
plan year beginning before the date that is 2 years after 
the date of the enactment of this Act. 
SEC. 103. OVERSIGHT OF PHARMACY BENEFITS MANAGER 
SERVICES. 
(a) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following: 
‘‘SEC. 9826. OVERSIGHT OF PHARMACY BENEFITS MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after the date that is 3 years after the date of enactment 
of this section, a group health plan, or an entity or sub-
sidiary providing pharmacy benefits management services 
on behalf of such a plan, shall not enter into a contract 
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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 an entity or 
subsidiary providing pharmacy benefits management serv-
ices on behalf of a plan, from making the report described 
in subsection (b). 
‘‘(b) ANNUAL REPORT.— 
‘‘(1) IN GENERAL.—With respect to plan years 
beginning on or after the date that is 3 years after 
the date of enactment of this section, for each such 
plan year, a group health plan, or an entity pro-
viding pharmacy benefits management services on 
behalf of such a plan, shall submit to the plan spon-
sor (as defined in section 3(16)(B) of the Employee 
Retirement Income Security Act of 1974) of such 
plan a report in a machine-readable format. Each 
such report shall include, with respect to such plan 
provided for such plan year— 
‘‘(A) to the extent feasible, information col-
lected from drug manufacturers (or an entity 
administering copay assistance on behalf of 
such manufacturers) by such plan (or entity or 
subsidiary providing pharmacy benefits manage-
ment services on behalf of such plan) on the 
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total amount of copayment assistance dollars 
paid, or copayment cards applied, that were 
funded by the drug manufacturer with respect 
to the participants and beneficiaries in such 
plan; 
‘‘(B) a list of each drug covered by such 
plan that was dispensed during the plan year, 
including, with respect to each such drug dur-
ing such plan year— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
‘‘(ii) the number of participants and 
beneficiaries for whom the drug was dis-
pensed during the plan year, the total 
number of prescription claims for the drug 
(including original prescriptions and re-
fills), and the total number of dosage units 
of the drug dispensed across the plan year, 
disaggregated by dispensing channel (such 
as retail, mail order, or specialty phar-
macy); 
‘‘(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 dosage unit; 
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‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; 
‘‘(v) for any drug for which gross 
spending of the group health plan exceeded 
$10,000 during the plan year— 
‘‘(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 the for-
mulary placement of such drug in that 
therapeutic category or class, if appli-
cable; 
‘‘(vi) the amount received, or expected 
to be received, from drug manufacturers in 
rebates, fees, alternative discounts, or 
other remuneration for claims incurred for 
such drug during the plan year; 
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‘‘(vii) the total net spending, after de-
ducting rebates, price concessions, alter-
native discounts or other remuneration 
from drug manufacturers, by the health 
plan on such drug; and 
‘‘(viii) 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 and its participants and bene-
ficiaries after manufacturer rebates, fees, 
and other remuneration for such drug dis-
pensed during the plan year; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
health plan during the plan year, and, with re-
spect to each such therapeutic category or class 
of drugs, during the plan year— 
‘‘(i) total gross spending by the plan, 
before manufacturer rebates, fees, or other 
manufacturer remuneration; 
‘‘(ii) the number of participants and 
beneficiaries who were dispensed a drug 
covered by such plan in that category or 
class, broken down by each such drug 
(identified by National Drug Code); 
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‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
and utilization management (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; and 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries, including 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; 
‘‘(D) total gross spending on prescription 
drugs by the plan during the plan year, before 
rebates and other manufacturer fees or remu-
neration; 
‘‘(E) total amount received, or expected to 
be received, by the health plan in drug manu-
facturer rebates, fees, alternative discounts, and 
all other remuneration received from the manu-
facturer or any third party, other than the plan 
sponsor, related to utilization of drug or drug 
spending under that health plan during the 
plan year; 
‘‘(F) the total net spending on prescription 
drugs by the health plan during the plan year; 
and 
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(such as retail, 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 dosage unit; 
‘‘(iv) the total out-of-pocket spending 
by participants, beneficiaries, and enrollees 
on such drug, including participant, bene-
ficiary, and enrollee spending through co-
payments, coinsurance, and deductibles; 
‘‘(v) for any drug for which gross 
spending of the group health plan or 
health 
insurance 
coverage 
exceeded 
$10,000 during the plan year— 
‘‘(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 the for-
mulary placement of such drug in that 
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