I 
118TH CONGRESS 
1ST SESSION H. R. 2679 
To amend the Public Health Service Act, the Employee Retirement Income 
Security Act, and the Internal Revenue Code of 1984 to increase over-
sight of pharmacy benefits manager services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 18, 2023 
Ms. KUSTER (for herself, Mr. CARTER of Georgia, Ms. ESHOO, and Mr. 
GUTHRIE) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Education and the Workforce, and Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee con-
cerned 
A BILL 
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act, and the Internal Revenue 
Code of 1984 to increase oversight of pharmacy benefits 
manager services, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Pharmacy Benefits 
Manager Accountability Act’’. 
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SEC. 2. OVERSIGHT OF PHARMACY BENEFITS 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 BENEFITS MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2025, a group health plan or health in-
surance issuer offering group health insurance coverage 
or an entity or subsidiary providing pharmacy benefits 
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, 2025, not less frequently 
than annually, a health insurance issuer offering 
group health insurance coverage or an entity pro-
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viding pharmacy benefits management services on 
behalf of a group health plan or an issuer providing 
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 cov-
erage 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 bene-
fits management services that was dispensed 
during the reporting period, including, with re-
spect to each such drug during the reporting 
period— 
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‘‘(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 
health 
insurance 
coverage 
exceeded 
$10,000 during the reporting period— 
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‘‘(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; 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
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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; 
‘‘(II) the total net spending, after 
deducting rebates, price concessions, 
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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-
neration received from the manufacturer or any 
third party, other than the plan sponsor, re-
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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 benefits 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.— 
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‘‘(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, the Comptroller 
General of the United States, 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-
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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 
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 2(d) of 
the Pharmacy Benefits Manager Accountability Act. 
‘‘(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.— 
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‘‘(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 benefits management services that 
violates subsection (a) or fails to provide information 
required under subsection (b) 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.—A health insurance 
issuer or entity providing pharmacy benefits man-
agement services that knowingly provides false infor-
mation 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 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 
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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 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 
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(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 
(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 BENEFITS MANAGER 
SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2025, a group health plan (or health in-
surance issuer offering group health insurance coverage 
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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). 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2025, not less frequently 
than annually, a health insurance issuer offering 
group health insurance coverage or an entity pro-
viding pharmacy benefits management services on 
behalf of a group health plan or an issuer providing 
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— 
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‘‘(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 bene-
fits 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; 
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‘‘(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; 
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‘‘(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-
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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 
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plan’s or health insurance issuer’s business to 
the pharmacy benefits 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 
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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, the Comptroller 
General of the United States, 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, 
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in accordance with the privacy requirements under 
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 2(d) of 
the Pharmacy Benefits Manager Accountability Act. 
‘‘(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) 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 Labor 
to a report described in subsection (b)(1) or information 
related to compliance with subsection (a) by such issuer, 
plan, or entity. 
‘‘(d) 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 
(B) in section 502 (29 U.S.C. 1132)— 
(i) in subsection (a)— 
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(I) in paragraph (6), by striking 
‘‘or (9)’’ and inserting ‘‘(9), or (13)’’; 
(II) in paragraph (10), by strik-
ing at the end ‘‘or’’; 
(III) in paragraph (11), at the 
end by striking the period and insert-
ing ‘‘; or’’; and 
(IV) by adding at the end the fol-
lowing new paragraph: 
‘‘(12) by the Secretary, in consultation with the 
Secretary of Health and Human Services, and the 
Secretary of the Treasury, to enforce section 726.’’; 
(ii) in subsection (b)(3), by inserting 
‘‘and subsections (a)(12) and (c)(13)’’ be-
fore ‘‘, the Secretary is not’’; and 
(iii) in subsection (c), by adding at 
the end the following new paragraph: 
‘‘(13) SECRETARIAL ENFORCEMENT AUTHORITY 
RELATING TO OVERSIGHT OF PHARMACY BENEFITS 
MANAGER SERVICES.— 
‘‘(A) FAILURE TO PROVIDE TIMELY INFOR-
MATION.—The Secretary, in consultation with 
the Secretary of Health and Human Services 
and the Secretary of the Treasury, may impose 
a penalty against any health insurance issuer or 
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entity providing pharmacy benefits management 
services that violates section 726(a) or fails to 
provide information required under section 
726(b) in the amount of $10,000 for each day 
during which such violation continues or such 
information is not disclosed or reported. 
‘‘(B) FALSE
INFORMATION.—The Sec-
retary, in consultation with the Secretary of 
Health and Human Services and the Secretary 
of the Treasury, may impose a penalty against 
a health insurance issuer or entity providing 
pharmacy benefits management services that 
knowingly provides false information under sec-
tion 726 in an amount not to exceed $100,000 
for each item of false information. Such penalty 
shall be in addition to other penalties as may 
be prescribed by law. 
‘‘(C) WAIVERS.—The Secretary may waive 
penalties under subparagraph (A), or extend 
the period of time for compliance with a re-
quirement of section 726, for an entity in viola-
tion of such section that has made a good-faith 
effort to comply with such section.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
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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 benefits 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 BENEFITS MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2025, 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, 2025, not less frequently 
than annually, an entity providing pharmacy benefits 
management services on behalf of a group health 
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plan shall submit to the plan sponsor (as defined in 
section 3(16)(B) of the Employee Retirement In-
come 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 in-
clude, with respect to the applicable 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 benefits 
management 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; 
‘‘(ii) the number of participants and 
beneficiaries for whom the drug was filled 
during the plan year, the total number of 
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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 
drugs or biosimilar biological products 
that are in the same therapeutic cat-
egory or class as such drug; and 
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‘‘(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 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; and 
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‘‘(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- 
day supply or 90-day supply, incurred 
by the health plan and its participants 
and beneficiaries, after manufacturer 
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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 
individual or firm who referred the group health 
plan’s business to the pharmacy benefits man-
ager. 
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‘‘(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-
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-
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