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(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1001 et seq.) 
is amended by inserting after the item relating to 
section 725 the following new item: 
‘‘Sec. 726. Oversight of pharmacy benefit manager services.’’. 
(c) 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 BENEFIT MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2024, a group health plan or an entity 
or subsidiary providing pharmacy benefits management 
services on behalf of such a plan shall not enter into a 
contract with a drug manufacturer, distributor, whole-
saler, subcontractor, 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 services on behalf of a plan, 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 
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than once every 6 months, an entity providing phar-
macy benefits management services on behalf of a 
group health plan shall submit to the plan sponsor 
(as defined in section 3(16)(B) of the Employee Re-
tirement Income Security Act of 1974) of such 
group health plan 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 applica-
ble group health plan— 
‘‘(A) as applicable, information collected 
from drug manufacturers by such entity on the 
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 or entity providing pharmacy benefit man-
agement services that was dispensed during the 
reporting period, including, with respect to each 
such drug during the reporting period— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
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‘‘(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 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 
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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 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 
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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— 
‘‘(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 on that category or 
class of drugs; and 
‘‘(III) the net price per course of 
treatment or single fill, such as a 30- 
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day supply or 90-day supply, incurred 
by the health plan and its participants 
and beneficiaries, after manufacturer 
rebates, 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 during the reporting period, 
before rebates and other manufacturer fees or 
remuneration; 
‘‘(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 re-
porting period; 
‘‘(F) the total net spending on prescription 
drugs by the health plan 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 
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individual or firm who referred the group health 
plan’s business to the pharmacy benefit man-
ager. 
‘‘(2) PRIVACY
REQUIREMENTS.—Entities pro-
viding pharmacy benefits management services on 
behalf of a group health plan shall provide informa-
tion 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 regula-
tions. 
‘‘(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 an entity providing phar-
macy benefits management services on behalf of 
a group health plan from placing reasonable re-
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strictions on the public disclosure of the infor-
mation contained in a report described in para-
graph (1), except that such entity may not re-
strict disclosure of such report to the Depart-
ment of Health and Human Services, the De-
partment 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.—An entity providing 
pharmacy benefits management services on behalf of 
a group health plan shall submit to the Comptroller 
General of the United States each of the first 4 re-
ports submitted to a plan sponsor under paragraph 
(1) with respect to such plan, and other such reports 
as requested, in accordance with the privacy require-
ments under paragraph (2), the disclosure and re-
disclosure standards under paragraph (3), the stand-
ards specified pursuant to paragraph (5), and such 
other information that the Comptroller General de-
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termines necessary to carry out the study under sec-
tion 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 entities required to submit re-
ports 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 Health and Human Services, shall enforce this 
section. 
‘‘(2) FAILURE TO PROVIDE TIMELY INFORMA-
TION.—An entity providing pharmacy benefit man-
agement services that violates subsection (a) or fails 
to provide information required under subsection 
(b), or a drug manufacturer that fails to provide in-
formation under subsection (b)(1)(A) in a timely 
manner, shall be subject to a civil monetary penalty 
in the amount of $10,000 for each day during which 
such violation continues or such information is not 
disclosed or reported. 
‘‘(3) FALSE
INFORMATION.—An entity pro-
viding pharmacy benefit management services, or 
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drug manufacturer that knowingly provides false in-
formation under this section shall be subject to a 
civil money penalty in an amount not to exceed 
$100,000 for each item of false information. Such 
civil money penalty shall be in addition to other pen-
alties 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. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit a group health plan or 
other entity to restrict disclosure to, or otherwise limit the 
access of, the Department of the Treasury to a report de-
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scribed in subsection (b)(1) or information related to com-
pliance with subsection (a) by such 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.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new item: 
‘‘Sec. 9826. Oversight of pharmacy benefit manager services.’’. 
(d) GAO STUDY.— 
(1) IN GENERAL.—Not later than 3 years after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to Con-
gress a report on— 
(A) pharmacy networks of group health 
plans, health insurance issuers, and entities 
providing pharmacy benefit management serv-
ices under such group health plan or group or 
individual health insurance coverage, including 
networks that have pharmacies that are under 
common ownership (in whole or part) with 
group health plans, health insurance issuers, or 
entities providing pharmacy benefit manage-
ment services or pharmacy benefit administra-
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(2) REQUIREMENT.—The Comptroller General 
of the United States shall ensure that the report 
under paragraph (1) does not contain information 
that would allow a reader to identify a specific plan 
or entity providing pharmacy benefits management 
services or otherwise contain commercial or financial 
information that is privileged or confidential. 
(3) DEFINITIONS.—In this subsection, the 
terms ‘‘group health plan’’, ‘‘health insurance cov-
erage’’, and ‘‘health insurance issuer’’ have the 
meanings given such terms in section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg–91). 
SEC. 603. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 
1395iii(b)(1)) 
is 
amended 
by 
striking 
‘‘$5,000,000’’ and inserting ‘‘$1,029,000,000’’. 
SEC. 604. LIMITATIONS ON AUTHORITY. 
In carrying out any program of the Substance Abuse 
and Mental Health Services Administration whose statu-
tory authorization is enacted or amended by this Act, the 
Secretary of Health and Human Services shall not allocate 
funding, or require award recipients to prioritize, dedicate, 
or allocate funding, without consideration of the incidence, 
prevalence, or determinants of mental health or substance 
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use issues, unless such allocation or requirement is con-
sistent with statute, regulation, or other Federal law. 
Passed the House of Representatives June 22, 2022. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
By KEVIN MCCUMBER, 
Deputy Clerk. 
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