group or individual health insurance coverage meets 
the requirements of this paragraph if such tool— 
‘‘(A) is based on an Internet website, mobile 
application, or other platform determined appro-
priate by the Secretary; 
‘‘(B) provides for real-time responses to re-
quests described in paragraph (1); 
‘‘(C) is updated in a manner such that in-
formation provided through such tool is accurate 
at the time such request is made; 
‘‘(D) allows such a request to be made with 
respect to an item or service furnished by— 
‘‘(i) a specific provider that is a par-
ticipating provider with respect to such 
item or service; 
‘‘(ii) all providers that are partici-
pating providers with respect to such plan 
and such item or service for purposes of fa-
cilitating price comparisons; or 
‘‘(iii) a provider that is not described 
in clause (ii); and 
‘‘(E) provides that such a request may be 
made with respect to an item or service through 
use of the billing code for such item or service or 
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through use of a descriptive term for such item 
or service. 
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 items and services. 
‘‘(4) PROVIDER
TOOL.—A group health plan, 
and a health insurance issuer offering group or indi-
vidual health insurance coverage, shall permit pro-
viders to learn the amount of cost-sharing (including 
deductibles, copayments, and coinsurance) that would 
apply under an individual’s plan or coverage that the 
individual would be responsible for paying with re-
spect to the furnishing of a specific item or service by 
another provider in a timely manner upon the request 
of the provider and with the consent of such indi-
vidual in the same manner and to the same extent as 
if such request has been made by such individual. As 
part of any tool used to facilitate such requests from 
a provider, such plan or issuer offering health insur-
ance coverage may include functionality that— 
‘‘(A) allows providers to submit the notifi-
cations to such plan or coverage required under 
section 2799B–6; and 
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‘‘(B) provides for notifications required 
under section 2799A–1(f) to such an individual. 
‘‘(d) RATE AND PAYMENT INFORMATION.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(9), the rate and payment information described in 
this subsection is, with respect to a group health plan 
or group or individual health insurance coverage (as 
applicable), the following: 
‘‘(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-network 
rate (in a dollar amount) in effect as of the first 
day of the plan year during which such informa-
tion is submitted with each provider (identified 
by national provider identifier) that is a partici-
pating provider with respect to such item or 
service (or, in the case such rate is not available 
in a dollar amount, such formulae, pricing 
methodologies, or other information used to cal-
culate such rate). 
‘‘(B) With respect to each dosage form and 
indication of each drug (identified by national 
drug code) for which benefits are available under 
such plan or coverage— 
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‘‘(i) the in-network rate (in a dollar 
amount) in effect as of the first day of the 
plan year during which such information is 
submitted with each provider (identified by 
national provider identifier) that is a par-
ticipating provider with respect to such 
drug (or, in the case such rate is not avail-
able in a dollar amount, such formulae, 
pricing methodologies, or other information 
used to calculate such rate); and 
‘‘(ii) the average amount paid by such 
plan (net of rebates, discounts, and price 
concessions) for such drug dispensed or ad-
ministered during the 90-day period begin-
ning 180 days before such date of submis-
sion to each provider that was a partici-
pating provider with respect to such drug, 
broken down by each such provider (identi-
fied by national provider identifier), 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. 
‘‘(C) With respect to each item or service for 
which benefits are available under such plan or 
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coverage, the amount billed, and the amount al-
lowed by the plan or coverage, for each such item 
or service furnished during the 90-day period 
specified in subparagraph (B) by a provider that 
was not a participating provider with respect to 
such item or service, broken down by each such 
provider (identified by national provider identi-
fier), other than items and services with respect 
to which fewer than 20 claims for such item or 
service were submitted to such plan or coverage 
during such period. 
Such rate and payment information shall be made 
available with respect to each individual item or serv-
ice, regardless of whether such item or service is paid 
for as part of a bundled payment, episode of care, 
value-based payment arrangement, or otherwise. 
‘‘(2) MANNER OF PUBLICATION.— 
‘‘(A) IN GENERAL.—Rate and payment in-
formation required to be made available under 
subsection (a)(9) shall be so made available in 
dollar amounts through 3 separate machine- 
readable files corresponding to the information 
described in each of subparagraphs (A) through 
(C) of paragraph (1) that meet such require-
ments as specified by the Secretary not later 
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than 180 days after the date of the enactment of 
this paragraph through rulemaking. Such re-
quirements shall ensure that such files are lim-
ited to an appropriate size, do not include infor-
mation that is duplicative of information con-
tained in other files made available under such 
subsection, are made available in a widely-avail-
able format that allows for information con-
tained in such files to be compared across group 
health plans and group or individual health in-
surance coverage, and are accessible to individ-
uals at no cost and without the need to establish 
a user account or provide other credentials. 
‘‘(B) REAL-TIME PROVISION OF INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), beginning January 1, 2026, rate and 
payment information required to be made 
available by a group health plan or health 
insurance issuer under subsection (a)(9) 
shall, in addition to being made available 
in the manner described in subparagraph 
(A), be made available through an applica-
tion program interface (or successor tech-
nology) that provides access to such infor-
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mation in real time and that meets such 
technical standards as may be specified by 
the Secretary. 
‘‘(ii) EXEMPTION FOR CERTAIN PLANS 
AND COVERAGE.—Clause (i) shall not apply 
with respect to information described in 
such clause required to be made available by 
a group health plan or health insurance 
issuer offering health insurance coverage if 
such plan or coverage, as applicable, pro-
vides benefits for fewer than 500 enrollees. 
‘‘(3) USER GUIDE.—The Secretary, Secretary of 
Labor, and Secretary of the Treasury shall jointly 
make available to the public instructions written in 
plain language explaining how individuals may 
search for information described in paragraph (1) in 
files submitted in accordance with paragraph (2). 
‘‘(4) ANNUAL SUMMARY.—For each year (begin-
ning with 2025), each group health plan and health 
insurance issuer offering group or individual health 
insurance coverage shall make public a machine-read-
able file meeting such standards as established by the 
Secretary under paragraph (2) containing a sum-
mary of all rate and payment information made pub-
lic by such plan or issuer with respect to such plan 
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or coverage during such year (such as averages of all 
such information so made public). 
‘‘(e) ATTESTATION.—Each group health plan and 
health insurance issuer offering group or individual health 
insurance coverage shall annually submit to the Secretary 
an attestation of such plan’s or such coverage’s compliance 
with the provisions of this section along with a link to dis-
closures made in accordance with subsection (a). 
‘‘(f) DEFINITIONS.—In this subsection: 
‘‘(1) PARTICIPATING PROVIDER.—The term ‘par-
ticipating provider’ has the meaning given such term 
in section 2799A–1 and includes a participating fa-
cility. 
‘‘(2) IN-NETWORK RATE.—The term ‘in-network 
rate’ means, with respect to a group health plan or 
group or individual health insurance coverage and an 
item or service furnished by a provider that is a par-
ticipating provider with respect to such plan or cov-
erage and item or service, the contracted rate (re-
flected as a dollar amount) in effect between such 
plan or coverage and such provider for such item or 
service.’’. 
(b) REPORTS TO CONGRESS.— 
(1) QUALITY REPORT.—Not later than 1 year 
after the date of enactment of this subsection, the Sec-
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retary of Labor shall submit to Congress a report on 
the feasibility of including data relating to the qual-
ity of health care items and services with the price 
transparency information required to be made avail-
able under the amendments made by subsection (a). 
Such report shall include recommendations for legis-
lative and regulatory actions to identify appropriate 
metrics for assessing and comparing quality of care. 
(2) TRANSPARENCY
DATA
ASSESSMENT.—Not 
later than January 1, 2026, and biannually there-
after through 2032, the Secretary shall submit to Con-
gress, and make publicly available on a website of the 
Department of Labor, a report with respect to the in-
formation described in section 719 of the Employee 
Retirement Income Security Act (29 U.S.C. 1185h) 
(as amended by the ‘‘Transparency in Coverage Act 
of 2023’’), assessing the differences in commercial ne-
gotiated prices— 
(A) between rural and urban markets; 
(B) in the individual, small-employer, and 
large-employer markets; 
(C) in consolidated and non-consolidated 
provider markets; 
(D) between non-profit and for-profit hos-
pitals; and 
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(E) between non-profit and for-profit insur-
ers. 
(c) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendments made by 
subsection (a) shall apply to plan years beginning on 
or after January 1, 2025. 
(2) CONTINUED APPLICABILITY OF RULES FOR 
PREVIOUS YEARS.—Nothing in the amendments made 
by subsection (a) may be construed as affecting the 
applicability of the rule entitled ‘‘Transparency in 
Coverage’’ published by the Department of the Treas-
ury, the Department of Labor, and the Department of 
Health and Human Services on November 12, 2020 
(85 Fed. Reg. 72158) for plan years beginning before 
January 1, 2025. 
SEC. 3. PHARMACY BENEFIT MANAGER TRANSPARENCY. 
(a) 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 following: 
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‘‘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 in 
connection with such a plan) or an entity or subsidiary 
providing pharmacy benefits management services on behalf 
of such a plan or issuer may not enter into a contract with 
a drug manufacturer, distributor, wholesaler, switch, pa-
tient or copay assistance program administrator, phar-
macy, subcontractor, rebate aggregator, or any associated 
third party that limits or delays the disclosure of informa-
tion to plan administrators in such a manner that prevents 
the plan or issuer, or an entity or subsidiary providing 
pharmacy benefits management services on behalf of a plan 
or issuer, from making or substantiating the reports de-
scribed in subsection (b). 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning on 
or after January 1, 2025, not less frequently than 
quarterly (and upon request by the plan adminis-
trator), a group health plan or health insurance 
issuer offering group health insurance coverage, or an 
entity providing pharmacy benefits management serv-
ices on behalf of a group health plan or an issuer pro-
viding group health insurance coverage, shall submit 
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to the plan administrator (as defined in section 
3(16)(A)) of such plan or coverage a report in accord-
ance with this subsection, and make such report 
available to the plan administrator in a machine- 
readable format (or as may be determined by the Sec-
retary, other formats). Each such report shall include, 
with respect to the applicable group health plan or 
health insurance coverage— 
‘‘(A) information collected from a patient or 
copay assistance program administrator by such 
entity on the total amount of copayment assist-
ance dollars paid, or copayment cards applied, 
or other discounts that were funded by the drug 
manufacturer with respect to the participants 
and beneficiaries in such plan or coverage; 
‘‘(B) total gross spending on prescription 
drugs by the plan or coverage during the report-
ing period; 
‘‘(C) total amount received, or expected to 
be received, by the plan or coverage from any en-
tities, in rebates, fees, alternative discounts, and 
all other remuneration received from the entity 
or any third party (including group purchasing 
organizations) other than the plan adminis-
trator, related to utilization of drug or drug 
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spending under such plan or coverage during the 
reporting period; 
‘‘(D) the total net spending on prescription 
drugs by the plan or coverage during such re-
porting period; 
‘‘(E) amounts paid, directly or indirectly, 
in rebates, fees, or any other type of compensa-
tion 
(as 
defined 
in 
section 
408(b)(2)(B)(ii)(dd)(AA)) to brokerage houses, 
brokers, consultants, advisors, or any other indi-
vidual or firm for the referral of the group health 
plan’s or health insurance issuer’s business to the 
pharmacy benefits manager, identified by the re-
cipient of such amounts; 
‘‘(F)(i) an explanation of any benefit design 
parameters that encourage or require partici-
pants and beneficiaries in the plan or coverage 
to fill prescriptions at mail order, specialty, or 
retail pharmacies that are affiliated with or 
under common ownership with the entity pro-
viding pharmacy benefit management services 
under such plan or coverage, including manda-
tory mail and specialty home delivery programs, 
retail and mail auto-refill programs, and cost- 
sharing assistance incentives funded by an entity 
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providing pharmacy benefit management serv-
ices; 
‘‘(ii) the percentage of total prescrip-
tions charged to the plan, issuer, or partici-
pants and beneficiaries in such plan or cov-
erage, that were dispensed by mail order, 
specialty, or retail pharmacies that are af-
filiated with or under common ownership 
with the entity providing pharmacy benefit 
management services; and 
‘‘(iii) a list of all drugs dispensed by 
such affiliated pharmacy or pharmacy 
under common ownership and charged to 
the plan, issuer, or participants and bene-
ficiaries of the plan, during the applicable 
period, and, with respect to each drug— 
‘‘(I)(aa) the amount charged, per 
dosage unit, per 30-day supply, and 
per 90-day supply, with respect to par-
ticipants and beneficiaries in the plan 
or coverage, to the plan or issuer; and 
‘‘(bb) the amount charged, 
per dosage unit, per 30-day sup-
ply, and per 90-day supply, to 
participants and beneficiaries; 
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‘‘(II) the median amount charged 
to the plan or issuer, per dosage unit, 
per 30-day supply, and per 90-day 
supply, including amounts paid by the 
participants and beneficiaries, when 
the same drug is dispensed by other 
pharmacies that are not affiliated with 
or under common ownership with the 
entity and that are included in the 
pharmacy network of such plan or cov-
erage; 
‘‘(III) the interquartile range of 
the costs, per dosage unit, per 30-day 
supply, and per 90-day supply, includ-
ing amounts paid by the participants 
and beneficiaries, when the same drug 
is dispensed by other pharmacies that 
are not affiliated with or under com-
mon ownership with the entity and 
that are included in the pharmacy net-
work of that plan or coverage; 
‘‘(IV) the lowest cost, per dosage 
unit, per 30-day supply, and per 90- 
day supply, for such drug, including 
amounts charged to the plan and par-
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ticipants and beneficiaries, that is 
available from any pharmacy included 
in the network of the plan or coverage; 
‘‘(V) the net acquisition cost per 
dosage unit, per 30-day supply, and 
per 90-day supply, if the drug is sub-
ject to a maximum price discount; and 
‘‘(VI) other information with re-
spect to the cost of the drug, as deter-
mined by the Secretary, such as aver-
age sales price, wholesale acquisition 
cost, and national average drug acqui-
sition cost per dosage unit or per 30- 
day supply, and per 90-day supply, 
for such drug, including amounts 
charged to the plan or issuer and par-
ticipants and beneficiaries among all 
pharmacies included in the network of 
such plan or coverage; and 
‘‘(G) in the case of a large employer— 
‘‘(i) a list of each drug covered by such 
plan, issuer, or entity providing pharmacy 
benefits management services for which a 
claim was filed during the reporting period, 
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including, with respect to each such drug 
during the reporting period— 
‘‘(I) the brand name, generic or 
non-proprietary name, and the Na-
tional Drug Code; 
‘‘(II)(aa) the number of partici-
pants and beneficiaries for whom a 
claim for such drug was filed during 
the reporting period, the total number 
of prescription claims for such drug 
(including original prescriptions and 
refills), and the total number of dosage 
units and total days supply of such 
drug for which a claim was filed dur-
ing the reporting period; and 
‘‘(bb) with respect to each 
claim or dosage unit described in 
item (aa), the type of dispensing 
channel used, such as retail, mail 
order, or specialty pharmacy; 
‘‘(III) the wholesale acquisition 
cost, listed as cost per days supply and 
cost per dosage unit on date of dis-
pensing; 
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‘‘(IV) 
the 
total 
out-of-pocket 
spending by participants and bene-
ficiaries on such drug after application 
of any benefits under such plan or cov-
erage, including participant and bene-
ficiary spending through copayments, 
coinsurance, and deductibles (but not 
including any amounts spent by par-
ticipants and beneficiaries on drugs 
not covered under such plan or cov-
erage, or for which no claim was sub-
mitted to such plan or coverage); 
‘‘(V) for any drug for which gross 
spending of the plan or coverage ex-
ceeded $10,000 during the reporting 
period— 
‘‘(aa) a list of all other drugs 
in the same therapeutic category 
or class, including brand name 
drugs, biological products, generic 
drugs, or biosimilar biological 
products that are in the same 
therapeutic category or class as 
such drug; and 
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‘‘(bb) the rationale for pre-
ferred formulary placement of 
such drug in that therapeutic cat-
egory or class, if applicable; and 
‘‘(ii) a list of each therapeutic category 
or class of drugs for which a claim was filed 
under the health plan or health insurance 
coverage during the reporting period, and, 
with respect to each such therapeutic cat-
egory or class of drugs during the reporting 
period— 
‘‘(I) total gross spending by the 
plan; 
‘‘(II) the number of participants 
and beneficiaries who filled a prescrip-
tion for a drug in that category or 
class; 
‘‘(III) if applicable to that cat-
egory or class, a description of the for-
mulary tiers and utilization mecha-
nisms (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 bene-
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‘‘(cc) the average net spend-
ing per 30-day supply and per 
90-day supply, incurred by the 
health plan or health insurance 
coverage and its participants and 
beneficiaries, among all drugs 
within the therapeutic class for 
which a claim was filed during 
the reporting period. 
‘‘(2) PRIVACY
REQUIREMENTS.—Health insur-
ance issuers offering group health insurance coverage 
and entities providing pharmacy benefits manage-
ment services on behalf of a group health plan shall 
provide information under paragraph (1) in a man-
ner consistent with the privacy, security, and breach 
notification regulations promulgated under section 
264(c) of the Health Insurance Portability and Ac-
countability 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 
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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 offer-
ing group health insurance coverage or an entity 
providing pharmacy benefits management serv-
ices on behalf of a group health plan from plac-
ing reasonable restrictions on the public disclo-
sure of the information contained in a report de-
scribed in paragraph (1), except that such 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 Sec-
retary shall define through rulemaking a limited 
form of the report under paragraph (1) required 
of plan administrators who are drug manufac-
turers, drug wholesalers, or other direct partici-
pants in the drug supply chain, in order to pre-
vent anti-competitive behavior. 
‘‘(4) REPORT
TO
GAO.—A health insurance 
issuer offering group health insurance coverage or an 
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entity providing pharmacy benefits management serv-
ices on behalf of a group health plan shall submit to 
the Comptroller General of the United States each of 
the first 4 reports submitted to a plan administrator 
under paragraph (1) with respect to such coverage or 
plan, and other such reports as requested, in accord-
ance with the privacy requirements under paragraph 
(2), the disclosure and redisclosure standards under 
paragraph (3), the standards specified pursuant to 
paragraph (5). 
‘‘(5) STANDARD
FORMAT.—Not later than 6 
months after the date of enactment of this section, the 
Secretary shall specify through rulemaking 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) DEFINITIONS.—In this section: 
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‘‘(1) LARGE EMPLOYER.—The term ‘large em-
ployer’ means, in connection with a group health 
plan with respect to a calendar year and a plan year, 
an employer who employed an average of at least 50 
employees on business days during the preceding cal-
endar year and who employs at least 1 employee on 
the first day of the plan year. 
‘‘(2) WHOLESALE ACQUISITION COST.—The term 
‘wholesale acquisition cost’ has the meaning given 
such term in section 1847A(c)(6)(B) of the Social Se-
curity Act.’’; and 
(B) in section 502 (29 U.S.C. 1132)— 
(i) in subsection (a)— 
(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, to enforce section 726.’’; 
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ssavage on LAPJG3WLY3PROD with BILLS
(ii) in subsection (b)(3), by inserting 
‘‘and subsections (a)(12) and (c)(13)’’ before 
‘‘, 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 may impose a penalty 
against any health insurance issuer or entity 
providing pharmacy benefits management serv-
ices that violates section 726(a) or fails to pro-
vide information required under section 726(b) 
in the amount of $10,000 for each day during 
which such violation continues or such informa-
tion is not disclosed or reported. 
‘‘(B) FALSE INFORMATION.—The Secretary 
may impose a penalty against a health insur-
ance issuer or entity providing pharmacy bene-
fits management services that knowingly pro-
vides false information under section 726 in an 
amount not to exceed $100,000 for each item of 
false information. Such penalty shall be in addi-
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