tion 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 requirement 
of section 726, for an entity in violation of such 
section that has made a good-faith effort to com-
ply with such section.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1001 et seq.) is 
amended by inserting after the item relating to sec-
tion 725 the following new item: 
‘‘Sec. 726. Oversight of pharmacy benefits manager services.’’. 
(b) PHSA.—Part D of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–111 et seq.) is amend-
ed 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 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-
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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 
to the plan administrator (as defined in section 
3(16)(A) of the Employee Retirement Income Security 
Act of 1974) of such plan or coverage a report in ac-
cordance 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, 
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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 
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; 
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‘‘(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) of the Employee Retire-
ment Income Security Act of 1974) to brokerage 
houses, brokers, consultants, advisors, or any 
other individual or firm for the referral of the 
group health plan’s or health insurance issuer’s 
business to the pharmacy benefits manager, iden-
tified by the recipient 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 
providing pharmacy benefit management serv-
ices; 
‘‘(ii) the percentage of total prescrip-
tions charged to the plan, issuer, or partici-
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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; 
‘‘(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 
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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-
ticipants and beneficiaries, that is 
available from any pharmacy included 
in the network of the plan or coverage; 
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‘‘(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, 
including, with respect to each such drug 
during the reporting period— 
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‘‘(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; 
‘‘(IV) 
the 
total 
out-of-pocket 
spending by participants and bene-
ficiaries on such drug after application 
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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 
‘‘(bb) the rationale for pre-
ferred formulary placement of 
such drug in that therapeutic cat-
egory or class, if applicable; and 
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‘‘(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-
ficiaries, including participant and 
beneficiary spending through copay-
ments, coinsurance, and deductibles; 
and 
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‘‘(V) for each drug— 
‘‘(aa) the amount received, or 
expected to be received, from any 
entity in rebates, fees, alternative 
discounts, or other remunera-
tion— 
‘‘(AA) for claims in-
curred during the reporting 
period; or 
‘‘(BB) that is related to 
utilization of drugs or drug 
spending; 
‘‘(bb) the total net spending, 
after deducting rebates, price con-
cessions, alternative discounts or 
other remuneration from drug 
manufacturers, by the health plan 
or health insurance coverage on 
that category or class of drugs; 
and 
‘‘(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 
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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 
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-
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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 issuer 
or entity may not restrict disclosure of such re-
port to the Department of Health and Human 
Services, the Department of Labor, the Depart-
ment 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 
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 
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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) ENFORCEMENT.— 
‘‘(1) FAILURE
TO
PROVIDE
TIMELY
INFORMA-
TION.—An entity providing pharmacy benefits man-
agement 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 dis-
closed or reported. 
‘‘(2) FALSE INFORMATION.—An entity providing 
pharmacy benefits management services that know-
ingly provides false information under this section 
shall be subject to a civil money penalty in an 
amount not to exceed $100,000 for each item of false 
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information. Such civil money penalty shall be in ad-
dition to other penalties as may be prescribed by law. 
‘‘(3) PROCEDURE.—The provisions of section 
1128A of the Social Security Act, other than sub-
section (a) and (b) and the first sentence of subsection 
(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 Security Act. 
‘‘(4) 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 section. 
‘‘(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 subsection 
(a) by such issuer, plan, or entity. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(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, 
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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.’’. 
(c) IRC.— 
(1) IN GENERAL.—Subchapter B of chapter 100 
of the Internal Revenue Code of 1986 is amended by 
adding at the end the following new section: 
‘‘SEC. 9826. OVERSIGHT OF PHARMACY BENEFITS MANAGER 
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 may not enter into a con-
tract with a drug manufacturer, distributor, wholesaler, 
switch, patient or copay assistance program administrator, 
pharmacy, subcontractor, rebate aggregator, or any associ-
ated third party that limits or delays the disclosure of infor-
mation to plan administrators in such a manner that pre-
vents the plan, or an entity or subsidiary providing phar-
macy benefits management services on behalf of a plan, 
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from making or substantiating the reports described in sub-
section (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 an entity providing 
pharmacy benefits management services on behalf of 
a group health plan, shall submit to the plan admin-
istrator (as defined in section 3(16)(A) of the Em-
ployee Retirement Income Security Act of 1974) of 
such plan a report in accordance with this subsection, 
and make such report available to the plan adminis-
trator in a machine-readable format (or as may be 
determined by the Secretary, other formats). Each 
such report shall include, with respect to the applica-
ble group health plan— 
‘‘(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; 
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‘‘(B) total gross spending on prescription 
drugs by the plan during the reporting period; 
‘‘(C) total amount received, or expected to 
be received, by the plan from any entities, in re-
bates, fees, alternative discounts, and all other 
remuneration received from the entity or any 
third party (including group purchasing organi-
zations) other than the plan administrator, re-
lated to utilization of drug or drug spending 
under such plan during the reporting period; 
‘‘(D) the total net spending on prescription 
drugs by the plan during such reporting 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) of the Employee Retire-
ment Income Security Act of 1974) to brokerage 
houses, brokers, consultants, advisors, or any 
other individual or firm for the referral of the 
group health plan’s business to the pharmacy 
benefits manager, identified by the recipient of 
such amounts; 
‘‘(F)(i) an explanation of any benefit design 
parameters that encourage or require partici-
pants and beneficiaries in the plan to fill pre-
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per 90-day supply, with respect to par-
ticipants and beneficiaries in the plan, 
to the plan; and 
‘‘(bb) the amount charged, 
per dosage unit, per 30-day sup-
ply, and per 90-day supply, to 
participants and beneficiaries; 
‘‘(II) the median amount charged 
to the plan, per dosage unit, per 30- 
day supply, and per 90-day supply, 
including amounts paid by the partici-
pants 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 net-
work of such plan; 
‘‘(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 
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that are included in the pharmacy net-
work of that plan; 
‘‘(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-
ticipants and beneficiaries, that is 
available from any pharmacy included 
in the network of the plan; 
‘‘(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 and participants 
and beneficiaries among all phar-
macies included in the network of such 
plan; and 
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‘‘(G) in the case of a large employer— 
‘‘(i) a list of each drug covered by such 
plan or entity providing pharmacy benefits 
management services for which a claim was 
filed during the reporting period, 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; 
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‘‘(III) the wholesale acquisition 
cost, listed as cost per days supply and 
cost per dosage unit on date of dis-
pensing; 
‘‘(IV) 
the 
total 
out-of-pocket 
spending by participants and bene-
ficiaries on such drug after application 
of any benefits under such plan, in-
cluding participant and beneficiary 
spending through copayments, coinsur-
ance, and deductibles (but not includ-
ing any amounts spent by participants 
and beneficiaries on drugs not covered 
under such plan, or for which no claim 
was submitted to such plan); 
‘‘(V) for any drug for which gross 
spending of the plan exceeded $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 
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therapeutic category or class as 
such drug; and 
‘‘(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 plan during the reporting period, 
and, with respect to each such therapeutic 
category or class of drugs during the report-
ing 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; 
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‘‘(IV) 
the 
total 
out-of-pocket 
spending by participants and bene-
ficiaries, including participant and 
beneficiary spending through copay-
ments, coinsurance, and deductibles; 
and 
‘‘(V) for each drug— 
‘‘(aa) the amount received, or 
expected to be received, from any 
entity in rebates, fees, alternative 
discounts, or other remunera-
tion— 
‘‘(AA) for claims in-
curred during the reporting 
period; or 
‘‘(BB) that is related to 
utilization of drugs or drug 
spending; 
‘‘(bb) the total net spending, 
after deducting rebates, price con-
cessions, alternative discounts or 
other remuneration from drug 
manufacturers, by the plan on 
that category or class of drugs; 
and 
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