TITLE 
I—INCREASING 
PRICE 
TRANSPARENCY 
TO 
LOWER 
COSTS 
SEC. 101. PRICE TRANSPARENCY REQUIREMENTS. 
(a) IN GENERAL.—Section 2718(e) of the Public 
Health Service Act (42 U.S.C. 300gg–18(e)) is amend-
ed— 
(1) by striking ‘‘Each hospital’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—Each hospital’’; 
(2) by inserting ‘‘, without subscription and 
free of charge, in a single machine-readable file,’’ 
after ‘‘a list’’; 
(3) by inserting ‘‘and a list, in plain language 
and without subscription and free of charge, in a 
consumer-friendly format, of the hospital’s standard 
charges for as many of the 70 Centers for Medicare 
& Medicaid Services-specified shoppable services that 
are provided by the hospital, and as many additional 
hospital-selected shoppable services (or all such addi-
tional services, if such hospital provides fewer than 
300 shoppable services) as may be necessary for a 
combined total of at least 300 shoppable services’’ 
after ‘‘Social Security Act’’; and 
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(4) by adding at the end the following: ‘‘Such 
lists shall be updated not less frequently than annu-
ally. Beginning January 1, 2024, each hospital shall 
include in its lists of standard charges, along with 
such additional information as the Secretary may re-
quire with respect to such charges for purposes of 
promoting public awareness of hospital pricing in 
advance of receiving a hospital item or service, the 
following: 
‘‘(A) A plain language description of each 
item or service included on such list, including, 
as applicable, the Healthcare Common Proce-
dure Coding System (HCPCS) code, the Diag-
nosis Related Group (DRG), the National Drug 
Code (NDC), or other payer identifier used or 
approved by the Centers for Medicare & Med-
icaid Services for such item or service. 
‘‘(B) The gross charge, expressed as a dol-
lar amount, for each such item or service, when 
provided in, as applicable, the hospital inpatient 
setting and outpatient department setting. 
‘‘(C) Any current payer-specific negotiated 
charges, clearly associated with the name of the 
third party payer and plan and expressed as a 
dollar amount, that applies to each such item or 
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service when provided in, as applicable, the hos-
pital inpatient setting and outpatient depart-
ment setting. 
‘‘(D) The de-identified maximum and min-
imum negotiated charges for each such item or 
service. 
‘‘(E) The discounted cash price, expressed 
as a dollar amount, for each such item or serv-
ice when provided in, as applicable, the hospital 
inpatient setting and outpatient department 
setting. If the discounted cash price is a per-
centage of another value provided, the cal-
culated value must be entered as a dollar 
amount. If the discounted cash price equates to 
the gross charge, the gross charge shall be re- 
entered to indicate that no cash discount is 
available. 
‘‘(2) DEEMED COMPLIANCE WITH SHOPPABLE 
SERVICES
REQUIREMENT
FOR
CERTAIN
YEARS.— 
With respect to a year before 2025, a hospital shall 
be deemed to meet the requirement of paragraph (1) 
that such hospital make available a list of standard 
charges for shoppable services if the hospital main-
tains an internet-based price estimator tool that 
meets the following requirements: 
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‘‘(A) The tool provides estimates for as 
many of the 70 Centers for Medicare & Med-
icaid Services specified shoppable services that 
are provided by the hospital, and as many addi-
tional hospital-selected shoppable services (or 
all such additional services, if such hospital pro-
vides fewer than 300 shoppable services) as 
may be necessary for a combined total of at 
least 300 shoppable services. 
‘‘(B) The tool allows health care con-
sumers to, at the time they use the tool, obtain 
an estimate of the amount they will be obligated 
to pay the hospital for the shoppable service. 
‘‘(C) The tool is prominently displayed on 
the hospital’s website and easily accessible to 
the public, without subscription, fee, or having 
to submit personal identifying information, and 
searchable by service description, billing code, 
and payer. 
The Secretary may not deem the establishment of an 
internet-based price estimator tool that meets the re-
quirements of this paragraph to constitute compli-
ance with the requirement of paragraph (1) that 
such hospital make available a list of standard 
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charges for shoppable services for 2025 or a subse-
quent year. 
‘‘(3) UNIFORM
METHOD
AND
FORMAT.—Not 
later than January 1, 2025, the Secretary shall im-
plement a standard, uniform method and format for 
hospitals to use in order to satisfy the requirements 
of this subsection for disclosing directly to the public 
charge and price information. Such method and for-
mat may be similar to any template established by 
the Centers for Medicare & Medicaid Services as of 
the date of the enactment of this paragraph for re-
porting such information under this subsection and 
shall meet such standards as determined appropriate 
by the Secretary. 
‘‘(4) MONITORING OF PRICING INFORMATION.— 
The Secretary, in consultation with the Inspector 
General of the Department of Health and Human 
Services, shall, through notice and comment rule-
making, establish a process to regularly monitor the 
accuracy and validity of pricing information dis-
played by each hospital pursuant to paragraph (1). 
‘‘(5) DEFINITIONS.—Notwithstanding any other 
provision of law, for the purpose of paragraphs (1) 
and (2): 
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‘‘(A) DE-IDENTIFIED
MAXIMUM
NEGO-
TIATED CHARGE.—The term ‘de-identified max-
imum negotiated charge’ means the highest 
charge that a hospital has negotiated with all 
third party payers for an item or service. 
‘‘(B) DE-IDENTIFIED
MINIMUM
NEGO-
TIATED CHARGE.—The term ‘de-identified min-
imum negotiated charge’ means the lowest 
charge that a hospital has negotiated with all 
third party payers for an item or service. 
‘‘(C) 
DISCOUNTED
CASH
PRICE.—The 
term ‘discounted cash price’ means the charge 
that applies to an individual who pays cash, or 
cash equivalent, for a hospital item or service. 
Hospitals that do not offer self-pay discounts 
may display the hospital’s undiscounted gross 
charges as found in the hospital chargemaster. 
‘‘(D) GROSS
CHARGE.—The term ‘gross 
charge’ means the charge for an individual item 
or service that is reflected on a hospital’s 
chargemaster, absent any discounts. 
‘‘(E) 
PAYER-SPECIFIC
NEGOTIATED 
CHARGE.—The term ‘payer-specific negotiated 
charge’ means the charge that a hospital has 
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negotiated with a third party payer for an item 
or service. 
‘‘(F) SHOPPABLE
SERVICE.—The term 
‘shoppable service’ means a service that can be 
scheduled by a health care consumer in ad-
vance. 
‘‘(G) THIRD
PARTY
PAYER.—The term 
‘third party payer’ means an entity that is, by 
statute, contract, or agreement, legally respon-
sible for payment of a claim for a health care 
item or service. 
‘‘(6) ENFORCEMENT.— 
‘‘(A) IN GENERAL.—In the case of a hos-
pital that fails to comply with this subsection— 
‘‘(i) the Secretary shall notify such 
hospital of such failure not later than 30 
days after the date on which the Secretary 
determines such failure exists; and 
‘‘(ii) not later than 45 days after the 
date of such notification, the hospital shall 
complete a corrective action plan to comply 
with such requirements. 
‘‘(B) CIVIL MONETARY PENALTY.— 
‘‘(i) IN GENERAL.—In addition to any 
other enforcement actions or penalties that 
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may apply under subsection (b)(3) or an-
other provision of law, a hospital that has 
received a notification under subparagraph 
(A)(i) and fails to satisfy the requirement 
under subparagraph (A)(ii) or otherwise 
comply with the requirements of this sub-
section by the date that is 90 days after 
such notification shall be subject to a civil 
monetary penalty of an amount— 
‘‘(I) in the case the hospital pro-
vides not more than 30 beds (as de-
termined 
under 
section 
180.90(c)(2)(ii)(D) of title 45, Code 
of Federal Regulations, as in effect on 
the date of the enactment of this 
paragraph), not to exceed $300 per 
day that the violation is ongoing as 
determined by the Secretary; and 
‘‘(II) in the case the hospital pro-
vides more than 30 beds (as so deter-
mined), equal to— 
‘‘(aa) subject to item (bb), 
$10 per bed per day that the vio-
lation is ongoing as determined 
by the Secretary, but for viola-
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tions occurring before January 1, 
2024, not to exceed $5,500 per 
each such day; or 
‘‘(bb) in the case such hos-
pital has failed to satisfy the re-
quirement under subparagraph 
(A)(ii) or otherwise comply with 
the requirements of this sub-
section for any continuous 1-year 
period beginning on or after Jan-
uary 1, 2024, and the amount 
otherwise imposed under item 
(aa) for such failure for such pe-
riod 
would 
be 
less 
than 
$5,000,000, an amount not less 
than $5,000,000. 
‘‘(ii) INCREASE
AUTHORITY.—In ap-
plying this subparagraph with respect to 
violations occurring in 2025 or a subse-
quent year, the Secretary may through no-
tice and comment rulemaking increase any 
dollar amount applied under this subpara-
graph by an amount specified by the Sec-
retary. 
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‘‘(iii) APPLICATION OF CERTAIN PRO-
VISIONS.—The provisions of section 1128A 
of the Social Security Act (other than sub-
sections (a) and (b) of such section) shall 
apply to a civil monetary penalty imposed 
under clause (i) in the same manner as 
such provisions apply to a civil monetary 
penalty imposed under subsection (a) of 
such section.’’. 
(b) PUBLICATION OF LIST OF HOSPITALS.— 
(1) LIST OF HOSPITALS.—Beginning not later 
than 90 days after the date of enactment of this 
Act, the Secretary of Health and Human Services 
(referred to in this section as the ‘‘Secretary’’) shall 
establish and maintain a publicly available list on 
the website of the Centers for Medicare & Medicaid 
Services of each hospital with respect to which the 
Secretary has conducted a review of such hospital’s 
compliance with the provisions of section 2718(e) of 
the Public Health Service Act (42 U.S.C. 300gg– 
18(e)). Such list shall include, with respect to each 
such hospital that was noncompliant with such pro-
visions, a specification as to whether such hospital— 
(A) has been issued a civil monetary pen-
alty; 
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(B) has received a warning notice; or 
(C) has submitted a corrective action plan. 
(2) ADDITIONS AND UPDATES.—In the case of 
a hospital not included on the list described in para-
graph (1) as of the date of the establishment of such 
list and that is subject to a review of such hospital’s 
compliance with the provisions described in such 
paragraph after such date, the Secretary shall add 
such hospital to such list, along with the specifica-
tions described in such paragraph, not later than 1 
business day after such review occurs. The Secretary 
shall update such specifications with respect to any 
hospital included on such list— 
(A) not later than 1 business day after any 
subsequent review of such hospital’s compliance 
with such provisions; and 
(B) not later than 1 business day after any 
penalty, notice, or request described in para-
graph (1) is made with respect to such hospital. 
(3) FOIA REQUESTS.—Any penalty, notice, or 
request described in paragraph (1) shall be subject 
to public disclosure, in full and without redaction, 
under section 552 of title 21, United States Code, 
notwithstanding any exemptions or exclusions other-
wise available under such section 552. 
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(4) REPORTS TO CONGRESS.—Not later than 1 
year after the date of enactment of this Act and 
each year thereafter, the Secretary of Health and 
Human Services shall submit to Congress, and make 
publicly available, a report that contains information 
regarding complaints of alleged violations of law and 
enforcement activities by the Secretary under the 
hospital price transparency rule implementing sec-
tion 2718(e) of the Public Health Service Act (42 
U.S.C. 300gg–18(e)). Such report shall be made 
available to the public on the website of the Centers 
for Medicare & Medicaid Services. Each such report 
shall include, with respect to the year involved— 
(A) the number of compliance and enforce-
ment inquiries opened by the Secretary pursu-
ant to such section; 
(B) the number of notices of noncompli-
ance issued by the Secretary based on such in-
quiries; 
(C) the identity of each hospital entity that 
received a notice of noncompliance and the na-
ture of the failure giving rise to the Secretary’s 
determination of noncompliance; 
(D) the amount of civil monetary penalty 
assessed against the hospital entity; 
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(E) whether the hospital entity subse-
quently corrected the noncompliance; and 
(F) an analysis of factors contributing to 
increasing health care costs. 
(5) GAO REPORT.—Not later than 1 year after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to the 
Committee on Energy and Commerce of the House 
of Representatives and the Committee on Health, 
Education, Labor, and Pensions of the Senate a re-
port on the compliance and enforcement with the 
hospital price transparency rule implementing sec-
tion 2718(e) of the Public Health Service Act (42 
U.S.C. 300gg–18(e)). The report shall include rec-
ommendations related to— 
(A) improving price transparency to pa-
tients, employers, and the public; and 
(B) 
increased 
civil 
monetary 
penalty 
amounts to ensure compliance. 
(6) REQUEST
FOR
INFORMATION.—Not later 
than January 1, 2025, the Secretary of Health and 
Human Services shall issue a public request for in-
formation as to the best method through which hos-
pitals may be required to publish quality data (such 
as data required to be reported under the Medicare 
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Hospital Compare program) alongside data required 
to be reported under section 2718(e) of the Public 
Health Service Act (42 U.S.C. 300gg–18(e)). 
(c) ENSURING ACCESSIBILITY THROUGH IMPLEMEN-
TATION.—In implementing the amendments made by this 
section, the Secretary of Health and Human Services shall 
through rulemaking ensure that a hospital submitting 
charges and information pursuant to such amendments 
takes reasonable steps (as specified by the Secretary) to 
ensure the accessibility of such charges and information 
to individuals with limited English proficiency. Such steps 
may include the hospital’s provision of interpretation serv-
ices or the hospital’s provision of translations of charges 
and information. 
SEC. 102. STRENGTHENING HEALTH INSURER TRANS-
PARENCY REQUIREMENTS. 
(a) 
TRANSPARENCY
IN
COVERAGE.—Section 
1311(e)(3)(C) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031(e)(3)(C)) is amended— 
(1) by striking ‘‘The Exchange’’ and inserting 
the following: 
‘‘(i) IN GENERAL.—The Exchange’’; 
(2) in clause (i), as inserted by paragraph (1)— 
(A) by striking ‘‘participating provider’’ 
and inserting ‘‘provider’’; 
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(B) by inserting ‘‘shall include the infor-
mation specified in clause (ii) and’’ after ‘‘such 
information’’; 
(C) by striking ‘‘an Internet website’’ and 
inserting ‘‘a self-service tool that meets the re-
quirements of clause (iii)’’; and 
(D) by striking ‘‘and such other’’ and all 
that follows through the period and inserting 
‘‘or, at the option such individual, through a 
paper or phone disclosure (as selected by such 
individual and provided at no cost to such indi-
vidual) that meets such requirements as the 
Secretary may specify.’’; and 
(3) by adding at the end the following new 
clauses: 
‘‘(ii) SPECIFIED
INFORMATION.—For 
purposes of clause (i), the information 
specified in this clause is, with respect to 
an item or service for which benefits are 
available under a health plan furnished by 
a health care provider, the following: 
‘‘(I) If such provider is a partici-
pating provider with respect to such 
item or service, the in-network rate 
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(as defined in subparagraph (F)) for 
such item or service. 
‘‘(II) If such provider is not de-
scribed in subclause (I), the maximum 
allowed amount for such item or serv-
ice. 
‘‘(III) The amount of cost shar-
ing 
(including 
deductibles, 
copay-
ments, and coinsurance) that the indi-
vidual will incur for such item or serv-
ice (which, in the case such item or 
service is to be furnished by a pro-
vider described in subclause (II), shall 
be calculated using the maximum 
amount described in such subclause). 
‘‘(IV) The amount the individual 
has already accumulated with respect 
to any deductible or out of pocket 
maximum under the plan (broken 
down, in the case separate deductibles 
or maximums apply to separate indi-
viduals enrolled in the plan, by such 
separate deductibles or maximums, in 
addition to any cumulative deductible 
or maximum). 
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‘‘(V) In the case such plan im-
poses any frequency or volume limita-
tions with respect to such item or 
service (excluding medical necessity 
determinations), the amount that such 
individual has accrued towards such 
limitation with respect to such item or 
service. 
‘‘(VI) Any prior authorization, 
concurrent review, step therapy, fail 
first, or similar requirements applica-
ble to coverage of such item or service 
under such plan. 
‘‘(iii) SELF-SERVICE TOOL.—For pur-
poses of clause (i), a self-service tool estab-
lished by a health plan meets the require-
ments of this clause if such tool— 
‘‘(I) is based on an internet 
website; 
‘‘(II) provides for real-time re-
sponses to requests described in such 
clause; 
‘‘(III) is updated in a manner 
such 
that 
information 
provided 
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through such tool is timely and accu-
rate; 
‘‘(IV) allows such a request to be 
made with respect to an item or serv-
ice furnished by— 
‘‘(aa) a specific provider 
that is a participating provider 
with respect to such item or serv-
ice; 
‘‘(bb) all providers that are 
participating providers with re-
spect to such plan and such item 
or service; or 
‘‘(cc) a provider that is not 
described in item (bb); and 
‘‘(V) 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 
through use of a descriptive term for 
such item or service. 
The Secretary may require such tool, as a 
condition of complying with subclause (V), 
to link multiple billing codes to a single de-
scriptive term if the Secretary determines 
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that the billing codes to be so linked cor-
respond to items and services.’’. 
(b) DISCLOSURE OF ADDITIONAL INFORMATION.— 
Section 1311(e)(3) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18031(e)(3)) is amended by add-
ing at the end the following new subparagraphs: 
‘‘(E) RATE
AND
PAYMENT
INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Not later than 
January 1, 2025, and every 3 months 
thereafter, each health plan shall submit to 
the Exchange, the Secretary, the State in-
surance commissioner, and make available 
to the public, the rate and payment infor-
mation described in clause (ii) in accord-
ance with clause (iii). 
‘‘(ii) RATE AND PAYMENT INFORMA-
TION DESCRIBED.—For purposes of clause 
(i), the rate and payment information de-
scribed in this clause is, with respect to a 
health plan, the following: 
‘‘(I) With respect to each item or 
service for which benefits are available 
under such plan, the in-network rate 
in effect as of the date of the submis-
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sion of such information with each 
provider (identified by national pro-
vider identifier) that is a participating 
provider with respect to such item or 
service, other than such a rate in ef-
fect with a provider that, during the 
1-year period ending on such date, 
submitted fewer than 10 claims for 
such item or service to such plan. 
‘‘(II) With respect to each drug 
(identified by national drug code) for 
which benefits are available under 
such plan, the average amount paid 
by such plan (net of rebates, dis-
counts, and price concessions) for 
such drug dispensed or administered 
during the 90-day period beginning 
180 days before such date of submis-
sion to each provider that was a par-
ticipating provider with respect to 
such drug, broken down by each such 
provider (identified by national pro-
vider identifier), other than such an 
amount paid to a provider that, dur-
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ing such period, submitted fewer than 
20 claims for such drug to such plan. 
‘‘(III) With respect to each item 
or service for which benefits are avail-
able under such plan, the amount 
billed, and the amount allowed by the 
plan, for each such item or service 
furnished during the 90-day period 
specified in subclause (II) by a pro-
vider that was not a participating pro-
vider with respect to such item or 
service, broken down by each such 
provider (identified by national pro-
vider identifier), other than items and 
services with respect to which fewer 
than 20 claims for such item or serv-
ice were submitted to such plan dur-
ing such period. 
‘‘(iii) MANNER OF SUBMISSION.—Rate 
and payment information required to be 
submitted and made available under this 
subparagraph shall be so submitted and so 
made available in 3 separate machine-read-
able files corresponding to the information 
described in each of subclauses (I) through 
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(III) of clause (ii) that meet such require-
ments as specified by the Secretary 
through rulemaking. Such requirements 
shall ensure that such files are limited to 
an appropriate size, are made available in 
a widely-available format that allows for 
information contained in such files to be 
compared across health plans, and are ac-
cessible to individuals at no cost and with-
out the need to establish a user account or 
provider other credentials. 
‘‘(iv) USER GUIDE.—Each health plan 
shall make available to the public instruc-
tions written in plain language explaining 
how individuals may search for information 
described in clause (ii) in files submitted in 
accordance with clause (iii). 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) PARTICIPATING PROVIDER.—The 
term ‘participating provider’ has the mean-
ing given such term in section 2799A–1 of 
the Public Health Service Act. 
‘‘(ii) IN-NETWORK
RATE.—The term 
‘in-network rate’ means, with respect to a 
health plan and an item or service fur-
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nished by a provider that is a participating 
provider with respect to such plan and 
item or service, the contracted rate in ef-
fect between such plan and such provider 
for such item or service.’’. 
(c) REPORTS.— 
(1) COMPLIANCE.—Not later than January 1, 
2025, the Comptroller General of the United States 
shall submit to Congress a report containing— 
(A) an analysis of health plan compliance 
with the amendments made by this section; 
(B) an analysis of enforcement of such 
amendments by the Secretaries of Health and 
Human Services, Labor, and the Treasury; 
(C) recommendations relating to improving 
such enforcement; and 
(D) recommendations relating to improving 
public disclosure, and public awareness, of in-
formation required to be made available by such 
plans pursuant to such amendments. 
(2) PRICES.—Not later than January 1, 2028, 
the Comptroller General of the United States shall 
submit to Congress a report containing an assess-
ment of differences in negotiated prices (and any 
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trends in such prices) in the private market be-
tween— 
(A) rural and urban areas; 
(B) the individual, small group, and large 
group markets; 
(C) 
consolidated 
and 
nonconsolidated 
health care provider areas (as specified by the 
Secretary); 
(D) nonprofit and for-profit hospitals; 
(E) nonprofit and for-profit insurers; and 
(F) insurers serving local or regional areas 
and insurers serving multistate or national 
areas. 
(d) ENSURING ACCESSIBILITY THROUGH IMPLEMEN-
TATION.—In implementing the amendments made by this 
section, the Secretary shall through rulemaking ensure 
that any entity making available information pursuant to 
such amendments takes reasonable steps (as specified by 
the Secretary) to ensure the accessibility of such to indi-
viduals with limited English proficiency. Such steps may 
include the entity’s provision of interpretation services or 
of translations of such information. 
(e) EFFECTIVE DATE.— 
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(1) IN GENERAL.—The amendments made by 
subsection (a) shall apply beginning January 1, 
2025. 
(2) CONTINUED APPLICABILITY OF RULES FOR 
PREVIOUS
YEARS.—Nothing in the amendments 
made by this section may be construed as affecting 
the applicability of the rule entitled ‘‘Transparency 
in Coverage’’ published by the Department of the 
Treasury, the Department of Labor, and the De-
partment of Health and Human Services on Novem-
ber 12, 2020 (85 Fed. Reg. 72158) before January 
1, 2025. 
SEC. 103. REQUIRING A SEPARATE IDENTIFICATION NUM-
BER AND AN ATTESTATION FOR EACH OFF- 
CAMPUS OUTPATIENT DEPARTMENT OF A 
PROVIDER. 
Section 1833(t) of the Social Security Act (42 U.S.C. 
1395l(t)) is amended by adding at the end the following 
new paragraph: 
‘‘(23) USE OF UNIQUE HEALTH IDENTIFIERS; 
ATTESTATION.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this subsection (or under an appli-
cable payment system pursuant to paragraph 
(21)) for items and services furnished on or 
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after January 1, 2026, by an off-campus out-
patient department of a provider (as defined in 
subparagraph (C)) unless— 
‘‘(i) such department has obtained, 
and such items and services are billed 
under, a standard unique health identifier 
for health care providers (as described in 
section 1173(b)) that is separate from 
such identifier for such provider; and 
‘‘(ii) such provider has submitted to 
the Secretary, during the 2-year period 
ending on the date such items and services 
are so furnished, an attestation that such 
department is compliant with the require-
ments described in section 413.65 of title 
42, Code of Federal Regulations (or a suc-
cessor regulation). 
‘‘(B) PROCESS FOR SUBMISSION AND RE-
VIEW.—Not later than 1 year after the date of 
enactment of this paragraph, the Secretary 
shall, through notice and comment rulemaking, 
establish a process for each provider with an 
off-campus outpatient department of a provider 
to submit an attestation pursuant to subpara-
graph (A)(ii), and for the Secretary to review 
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each such attestation and determine, through 
site visits or through remote audits (as deter-
mined appropriate by the Secretary), whether 
such department is compliant with the require-
ments described in such subparagraph. 
‘‘(C) OFF-CAMPUS
OUTPATIENT
DEPART-
MENT OF A PROVIDER DEFINED.—For purposes 
of this paragraph, the term ‘off-campus out-
patient department of a provider’ means a de-
partment of a provider (as defined in section 
413.65 of title 42, Code of Federal Regulations, 
or any successor regulation) that is not lo-
cated— 
‘‘(i) on the campus (as defined in such 
section) of such provider; or 
‘‘(ii) within the distance (described in 
such definition of campus) from a remote 
location of a hospital facility (as defined in 
such section).’’. 
SEC. 104. MANDATORY REPORTING WITH RESPECT TO CER-
TAIN HEALTH-RELATED OWNERSHIP INFOR-
MATION. 
Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by adding at the end 
the following new section: 
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‘‘SEC. 1150D. MANDATORY REPORTING WITH RESPECT TO 
CERTAIN HEALTH-RELATED OWNERSHIP IN-
FORMATION. 
‘‘(a) MANDATORY REPORTING WITH RESPECT CER-
TAIN HEALTH-RELATED OWNERSHIP INFORMATION.— 
‘‘(1) INITIAL REPORT.—Not later than January 
1, 2025 (or in the case of a specified entity formed 
after January 1, 2025, within 60 days of becoming 
a specified entity), each specified entity (as defined 
in subsection (f)(5)) shall submit to the Secretary, 
in a form and manner specified by the Secretary, a 
report containing the following information: 
‘‘(A) Data on mergers, acquisitions, and 
changes in ownership with respect to such spec-
ified entity for the previous 1-year period. 
‘‘(B) In the case that a specified entity is, 
or includes, a hospital, the additional informa-
tion described in subsection (b). 
‘‘(C) As applicable, the name, address, and 
business structure of the parent company of 
such specified entity (including the tax status of 
such parent company), as of the date of the 
submission of this report. 
‘‘(D) Any other information with respect to 
ownership of a specified entity, as determined 
by the Secretary. 
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‘‘(2) SUBSEQUENT REPORTS.—Not later than 1 
year after submitting the report under paragraph 
(1), and annually thereafter, each specified entity 
shall submit to the Secretary an updated report, in-
cluding— 
‘‘(A)(i) data on mergers, acquisitions, and 
changes in ownership with respect to such enti-
ties for the previous 1-year period; and 
‘‘(ii) any other information with re-
spect to ownership of a specified entity, as 
determined by the Secretary; and 
‘‘(B) in the case that a specified entity is, 
or includes, a hospital, the additional informa-
tion described in subsection (b). 
‘‘(b) ADDITIONAL
INFORMATION
SUBMITTED
BY 
CERTAIN SPECIFIED ENTITIES.—For purposes of para-
graphs (1)(B) and (2)(B) of subsection (a), with respect 
to a specified entity that is, or includes, a hospital, the 
information described in this subsection is the following 
information with respect to the previous 1-year period: 
‘‘(1) The business structure of the specified en-
tity, including the business type and the tax status 
of such entity. 
‘‘(2) The average debt-to-earnings ratio of the 
specified entity. 
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‘‘(3) The average amount of debt incurred— 
‘‘(A) by the hospital; and 
‘‘(B) by the entire specified entity. 
‘‘(4) Information with respect to real estate 
leases and purchases for property used, or intended 
to be used, to furnish or otherwise support the provi-
sion of health care services. 
‘‘(5) In the case of a non-profit hospital, a sub-
sidiary of a non-profit hospital, or a 501(c)(3) entity 
that shares common ownership with a non-profit 
hospital, capital gains investments (disaggregated by 
the type of investment) and any taxes paid on such 
gains from such investments. 
‘‘(6) As applicable, information with respect to 
the parent company of such specified entity. 
‘‘(c) PUBLIC REPORTING.—Not later than January 
1, 2027, and annually thereafter, the Secretary shall post 
on a publicly available website of the Department of 
Health and Human Services a report with respect to the 
previous 1-year period, including— 
‘‘(1) the number of specified entities reporting 
for such year, disaggregated by the business struc-
ture of each specified entity; 
‘‘(2) the number of owners of each specified en-
tity; 
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‘‘(3) any change in ownership for each specified 
entity; 
‘‘(4) any change in the tax status of a specified 
entity; 
‘‘(5) an analysis of trends in horizontal and 
vertical consolidation, disaggregated by business 
structure and provider type; and 
‘‘(6) as applicable, the name, address, and busi-
ness structure of the parent company of such speci-
fied entity (including the business type and the tax 
status of such parent company). 
‘‘(d) AUDITS.—The Secretary shall conduct an an-
nual audit consisting of a random sample of specified enti-
ties to verify compliance with the requirements of this sec-
tion and the accuracy of information submitted pursuant 
to this section. 
‘‘(e) PENALTY FOR FAILURE TO REPORT.—If a spec-
ified entity fails to provide a complete report under sub-
section (a), or submits a report containing false informa-
tion, such entity shall be subject to a civil monetary pen-
alty of not more than $5,000,000 for each such report 
not provided or containing false information. Such penalty 
shall be imposed and collected in the same manner as civil 
money penalties under subsection (a) of section 1128A are 
imposed and collected under that section. 
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‘‘(f) INAPPLICABILITY OF PAPERWORK REDUCTION 
ACT.—Chapter 35 of title 44, United States Code, shall 
not apply to collections of information made under this 
section. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) HEALTH PLAN.—The term ‘health plan’ 
has the meaning given such term in section 
1128C(c). 
‘‘(2) HOSPITAL.—The term ‘hospital’ has the 
meaning given such term in section 1861(e). 
‘‘(3) INDEPENDENT
FREESTANDING
EMER-
GENCY DEPARTMENT.—The term ‘independent free-
standing emergency department’ has the meaning 
given such term in section 2799A–1(a)(3)(D) of the 
Public Health Service Act. 
‘‘(4) PRIVATE
EQUITY
COMPANY.—The term 
‘private equity company’ means a publicly-traded or 
non-publicly traded company that collects capital in-
vestments from individuals or entities and purchases 
an ownership share of a provider of services (as de-
fined in section 1861(u)). 
‘‘(5) SPECIFIED ENTITY.—The term ‘specified 
entity’ means— 
‘‘(A) a hospital; 
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‘‘(B) a physician-owned physician practice 
with more than 25 physicians for a year; 
‘‘(C) a physician practice owned by a hos-
pital, a health plan, a private equity company, 
or a venture capital firm; 
‘‘(D) an ambulatory surgical center meet-
ing the standards specified under section 
1832(a)(2)(F)(i); or 
‘‘(E) an independent freestanding emer-
gency department. 
‘‘(6) VENTURE CAPITAL FUND.—The term ‘ven-
ture capital fund’ has the meaning given such term 
in section 275.203(l)–1 of title 17, Code of Federal 
Regulations.’’. 
SEC. 105. INCREASING PRICE TRANSPARENCY OF CLINICAL 
DIAGNOSTIC 
LABORATORY 
TESTS 
UNDER 
THE MEDICARE PROGRAM. 
Section 1846 of the Social Security Act (42 U.S.C. 
1395w–2) is amended— 
(1) in the header, by inserting ‘‘AND ADDI-
TIONAL
REQUIREMENTS’’ after ‘‘SANCTIONS’’; 
and 
(2) by adding at the end the following new sub-
section: 
‘‘(c) PRICE TRANSPARENCY REQUIREMENT.— 
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‘‘(1) IN
GENERAL.—Beginning January 1, 
2025, each provider of services or supplier that is 
available to furnish any specified clinical diagnostic 
laboratory test under this title shall— 
‘‘(A) make publicly available on an internet 
website the information described in paragraph 
(2) with respect to each such specified clinical 
diagnostic laboratory test that such provider or 
supplier is so available to furnish; and 
‘‘(B) ensure that such information is up-
dated not less frequently than annually. 
‘‘(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), the information described in this 
paragraph is, with respect to a provider of services 
or supplier and a specified clinical diagnostic labora-
tory test, the following: 
‘‘(A) The discounted cash price for such 
test (or, if no such price exists, the gross 
charge for such test). 
‘‘(B) The deidentified minimum negotiated 
rate in effect between such provider or supplier 
and any group health plan or group or indi-
vidual health insurance coverage for such test. 
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‘‘(C) The deidentified maximum negotiated 
rate in effect between such provider or supplier 
and any such plan or coverage for such test. 
‘‘(3) INCLUSION
OF
ANCILLARY
SERVICES.— 
Any price or rate for a specified clinical diagnostic 
laboratory test available to be furnished by a pro-
vider of services or supplier made publicly available 
in accordance with paragraph (1) shall include the 
price or rate (as applicable) for any ancillary item 
or service (such as specimen collection services) that 
would normally be furnished by such provider or 
supplier as part of such test, as specified by the Sec-
retary. 
‘‘(4) ENFORCEMENT.— 
‘‘(A) IN GENERAL.—In the case that the 
Secretary determines that a provider of services 
or supplier is not in compliance with paragraph 
(1)— 
‘‘(i) not later than 30 days after such 
determination, the Secretary shall notify 
such provider or supplier of such deter-
mination; 
‘‘(ii) not later than 90 days after such 
notification is sent, such provider or sup-
plier shall complete a corrective action plan 
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to comply with such paragraph and submit 
such plan to the Secretary; and 
‘‘(iii) if such provider or supplier con-
tinues to fail to comply with such para-
graph after the date that is 90 days after 
such notification is sent, the Secretary may 
impose a civil monetary penalty in an 
amount not to exceed $300 for each day 
(beginning with the date that is 91 days 
after such notification was sent) during 
which such failure is ongoing. 
‘‘(B) APPLICATION
OF
CERTAIN
PROVI-
SIONS.—The provisions of section 1128A (other 
than subsections (a) and (b) of such section) 
shall apply to a civil monetary penalty imposed 
under this paragraph in the same manner as 
such provisions apply to a civil monetary pen-
alty imposed under subsection (a) of such sec-
tion. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) 
GROUP
HEALTH
PLAN; 
GROUP 
HEALTH
INSURANCE
COVERAGE; INDIVIDUAL 
HEALTH
INSURANCE
COVERAGE.—The terms 
‘group health plan’, ‘group health insurance 
coverage’, and ‘individual health insurance cov-
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erage’ have the meaning given such terms in 
section 2791 of the Public Health Service Act. 
‘‘(B) SPECIFIED
CLINICAL
DIAGNOSTIC 
LABORATORY TEST.—the term ‘specified clinical 
diagnostic laboratory test’ means a clinical di-
agnostic laboratory test that is included on the 
list of shoppable services specified by the Cen-
ters for Medicare & Medicaid Services (as de-
scribed in section 180.60 of title 42, Code of 
Federal Regulations (or a successor regula-
tion)).’’. 
SEC. 106. PROMOTING TRANSPARENCY OF COMMON OWN-
ERSHIP INTERESTS UNDER PARTS C AND D 
OF THE MEDICARE PROGRAM. 
(a) MEDICARE ADVANTAGE.—Section 1857(e) of the 
Social Security Act (42 U.S.C. 1395w–27(e)) is amended 
by adding at the end the following new paragraph: 
‘‘(6) REQUIRED DISCLOSURE OF CERTAIN IN-
FORMATION RELATING TO HEALTH CARE PROVIDER 
OWNERSHIP.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2025, a contract 
under this section with an MA organization 
shall require the organization to report to the 
Secretary, not later than 1 year after the last 
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day of such plan year, the information de-
scribed in subparagraph (B) with respect to 
such plan year. 
‘‘(B) INFORMATION DESCRIBED.—For pur-
poses of subparagraph (A), the information de-
scribed in this subparagraph is, with respect to 
an MA organization and a plan year, the fol-
lowing: 
‘‘(i) The number of items and services 
furnished during such plan year by each 
specified provider (as defined in subpara-
graph (C)) for which payment was made 
by such organization. 
‘‘(ii) The number of items and serv-
ices furnished during such plan year by 
providers of services or suppliers not de-
scribed in clause (i) for which payment was 
made by such organization. 
‘‘(iii) The average per-enrollee number 
of qualifying diagnoses (as defined in sub-
paragraph (C)) made during such plan 
year by specified providers (including 
through chart reviews and health risk as-
sessments) with respect to individuals en-
rolled under an MA plan offered by such 
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organization, broken down by site of serv-
ice of such providers, as specified by the 
Secretary. 
‘‘(iv) The average per-enrollee number 
of qualifying diagnoses made during such 
plan year by providers of services and sup-
pliers not described in clause (iii) (includ-
ing through such reviews and assessments) 
with respect to such individuals, broken 
down by site of service of such providers. 
‘‘(v) The average risk score (as cal-
culated under the methodology described in 
subparagraph (C)(i)) for such an indi-
vidual for such plan year who received 
items and services from a specified pro-
vider during such plan year. 
‘‘(vi) The average risk score for such 
an individual for such plan year who did 
not receive items and services from a speci-
fied provider during such plan year. 
‘‘(vii) The average risk score for such 
an individual for such plan year who re-
ceived a health risk assessment from an 
assessment entity that was a specified as-
sessment entity during such plan year. 
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‘‘(viii) The average risk score for such 
an individual for such plan year who re-
ceived a health risk assessment from an 
assessment entity that was not a specified 
assessment entity during such plan year. 
‘‘(ix) The number of prior authoriza-
tion requests for an item or service sub-
mitted to such organization during such 
plan year, the number of such requests 
that were approved, the number of such re-
quests that were denied, and the number 
of such denied requests that were subse-
quently appealed and then approved, bro-
ken down by whether the entity proposing 
to furnish such item or service was a speci-
fied provider or not a specified provider. 
‘‘(x) The total amount of incentive- 
based payments made to, and the total 
amount of shared losses recoupments col-
lected from, specified providers during 
such plan year. 
‘‘(xi) The total amount of incentive- 
based payments made to, and the total 
amount of shared losses recoupments col-
lected from, providers of services and sup-
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pliers not described in clause (x) during 
such plan year. 
‘‘(xii) The allowed amount, and the 
amount of cost sharing imposed, with re-
spect to each item and service furnished 
during such plan year by specified pro-
viders paid by such organization. 
‘‘(xiii) The allowed amount, and the 
amount of cost sharing imposed, with re-
spect to each item and service furnished 
during such plan year by providers of serv-
ices and suppliers not described in clause 
(xii) paid by such organization. 
‘‘(xiv) For each MA plan offered by 
such organization during such plan year— 
‘‘(I) the total amount of pay-
ments made under section 1853(a)(1) 
to such organization for coverage of 
individuals under such plan, and the 
total amount of payments made by 
such individuals to such organization 
for coverage under such plan; 
‘‘(II) the total amount expended 
under such plan as payment for items 
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justment methodology established by the 
Secretary pursuant to section 1853(a)(3). 
‘‘(iii) SPECIFIED
ASSESSMENT
ENTI-
TY.—The term ‘specified assessment enti-
ty’ means, with respect to an MA organiza-
tion and a plan year, an assessment entity 
with respect to which such organization (or 
any person with an ownership or control 
interest (as defined in section 1124(a)(3)) 
in such organization) is a person with an 
ownership or control interest (as so de-
fined). 
‘‘(iv) 
SPECIFIED
PROVIDER.—The 
term ‘specified provider’ means, with re-
spect to an MA organization and a plan 
year, a provider of services or supplier with 
respect to which such organization (or any 
person with an ownership or control inter-
est (as defined in section 1124(a)(3)) in 
such organization) is a person with an 
ownership or control interest (as so de-
fined). 
‘‘(D) NONAPPLICATION
OF
PAPERWORK 
REDUCTION
ACT.—Chapter 35 of title 44, 
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United States Code, shall not apply to informa-
tion collected under this paragraph.’’. 
(b) PHARMACY BENEFIT MANAGER AND PHARMACY 
INFORMATION.—Section 1860D–12(b) of the Social Secu-
rity Act (42 U.S.C. 1395w–112(b)) is amended by adding 
at the end the following new paragraphs: 
‘‘(9) PROVISION OF INFORMATION RELATING TO 
PHARMACY OWNERSHIP.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2025, a contract 
entered into under this part with a PDP spon-
sor shall require the sponsor to report to the 
Secretary, not later than 1 year after the last 
day of such plan year, the information de-
scribed in subparagraph (B) with respect to 
such plan year. 
‘‘(B) INFORMATION DESCRIBED.—For pur-
poses of subparagraph (A), the information de-
scribed in this subparagraph is, for each pre-
scription drug plan offered by a PDP sponsor 
for a plan year, the following: 
‘‘(i) The negotiated price for each cov-
ered part D drug for which benefits are 
available under such plan for each network 
pharmacy (including an identification of 
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whether each such pharmacy is a specified 
pharmacy). 
‘‘(ii) The average per-drug amount of 
direct and indirect remuneration paid by 
specified pharmacies for such covered part 
D drugs dispensed during such plan year 
under such plan. 
‘‘(iii) The average per-drug amount of 
direct and indirect remuneration paid by 
pharmacies not described in clause (ii) for 
such covered part D drugs dispensed dur-
ing such plan year under such plan. 
‘‘(C) DEFINITIONS.—In this paragraph: 
‘‘(i) DIRECT
AND
INDIRECT
REMU-
NERATION.—The term ‘direct and indirect 
remuneration’ has the meaning given such 
term in section 423.308 of title 42, Code 
of Federal Regulations (or any successor 
regulation). 
‘‘(ii) 
NETWORK
PHARMACY.—The 
term ‘network pharmacy’ has the meaning 
given such term in section 423.100 of title 
42, Code of Federal Regulations (or any 
successor regulation). 
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‘‘(iii) NEGOTIATED PRICE.—The ‘ne-
gotiated price’ for a covered part D drug 
shall take into account all negotiated price 
concessions, such as discounts, direct or in-
direct subsidies, rebates, and direct or indi-
rect remunerations, for such drug, and in-
clude any dispensing fee for such drug. 
‘‘(iv) 
SPECIFIED
PHARMACY.—The 
term ‘specified pharmacy’ means, with re-
spect to an PDP sponsor and a plan year, 
a pharmacy with respect to which such 
sponsor (or any person with an ownership 
or control interest (as defined in section 
1124(a)(3)) in such sponsor) is a person 
with an ownership or control interest (as 
so defined). 
‘‘(D) NONAPPLICATION
OF
PAPERWORK 
REDUCTION
ACT.—Chapter 35 of title 44, 
United States Code, shall not apply to informa-
tion collected under this paragraph. 
‘‘(10) PROVISION OF INFORMATION BY PHAR-
MACY BENEFIT MANAGERS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2025, a contract 
entered into under this part with a PDP spon-
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sor shall prohibit such sponsor from entering 
into a contract with a specified pharmacy ben-
efit manager for purposes of performing any 
service with respect to covered part D drugs 
dispensed under any prescription drug plan of-
fered by such sponsor for such plan year unless 
such manager agrees to report to the Secretary, 
not later than 1 year after the last day of such 
plan year, the information described in subpara-
graph (B) with respect to each prescription 
drug plan for which such manager is providing 
any such service during such plan year, regard-
less of the sponsor of such plan. 
‘‘(B) INFORMATION DESCRIBED.—For pur-
poses of subparagraph (A), the information de-
scribed in this subparagraph is, with respect to 
a pharmacy benefit manager performing serv-
ices under a prescription drug plan for a plan 
year, the following: 
‘‘(i) With respect to the total amount 
of pharmacy and manufacturer rebates col-
lected by such manager (or collected on be-
half of such plan by any other entity with 
a contract in effect with such manager for 
such collection) for all covered part D 
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drugs dispensed under such plan during 
such plan year— 
‘‘(I) the total amount of such re-
bates passed through to the PDP 
sponsor of such plan; and 
‘‘(II) the total amount of such re-
bates retained by such manager or 
such other entities. 
‘‘(ii) The total amount paid by such 
manager to pharmacies for drugs furnished 
under such plan during such plan year. 
‘‘(iii) The total amount of payments 
made by such sponsor to such manager as 
reimbursement for such manager’s pay-
ments described in clause (ii). 
‘‘(iv) The total amount of payments 
made by such sponsor to such manager as 
fees for services furnished by such man-
ager with respect to such plan for such 
plan year (not including payments de-
scribed in clause (iii)). 
‘‘(v) The total amount of administra-
tive costs incurred by such manager for 
furnishing such services under such plan 
for such plan year. 
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‘‘(vi) A specification as to whether 
such manager is a specified pharmacy ben-
efit manager with respect to the PDP 
sponsor of such plan. 
‘‘(C) DEFINITION.—In this paragraph, the 
term ‘specified pharmacy benefit manager’ 
means, with respect to an PDP sponsor and a 
plan year, a pharmacy benefit manager with re-
spect to which such sponsor (or any person with 
an ownership or control interest (as defined in 
section 1124(a)(3)) in such sponsor) is a person 
with an ownership or control interest (as so de-
fined).’’. 
(c) ENCOUNTER DATA.—Section 1859 of the Social 
Security Act (42 U.S.C. 1395w–28) is amended by adding 
at the end the following new subsection: 
‘‘(j) INCLUSION OF CERTAIN INFORMATION IN EN-
COUNTER DATA.— 
‘‘(1) IN GENERAL.—In the case of any encoun-
ter data submitted by a Medicare Advantage plan 
with respect to an item or service furnished to an in-
dividual under such plan during a plan year begin-
ning on or after January 1, 2025, the Secretary 
shall require that such data include— 
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‘‘(A) the allowed amount for such item or 
service; 
‘‘(B) the amount of cost sharing (including 
deductibles, copayments, and coinsurance) im-
posed for such item or service; 
‘‘(C) in the case such individual was fur-
nished, during such plan year before such item 
or service was so furnished, an at-home health 
risk assessment from a specified assessment en-
tity, an indicator that such individual was so 
furnished such an assessment by such an entity; 
and 
‘‘(D) in the case such individual was fur-
nished, during such plan year before such item 
or service was so furnished, an at-home health 
risk assessment from an assessment entity not 
described in subparagraph (C), an indicator 
(distinct from the indicator described in such 
subparagraph) that such individual was so fur-
nished such an assessment by such an entity. 
‘‘(2) DEFINITIONS.—For purposes of this sub-
section, the terms ‘assessment entity’ and ‘specified 
assessment entity’ have the meaning given such 
terms in section 1857(e)(6).’’. 
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(d) MEDPAC REPORT.—Not later than December 
31, 2027, and every 2 years thereafter, the Medicare Pay-
ment Advisory Commission shall submit to Congress a re-
port on the effects of vertical integration in the health care 
sector on the Medicare program. Such report shall include 
an analysis of the effects of entities such as health care 
providers, pharmacies, PDP sponsors, Medicare Advan-
tage organizations, and pharmacy benefit managers that 
were previously under separate ownership from one an-
other coming under common ownership. 
(e) PUBLICATION.—Not later than January 1, 2027, 
the Secretary of Health and Human Services shall estab-
lish a process under which information submitted to the 
Secretary pursuant to the amendments made by sub-
sections (a) and (b) is publicly disclosed. Such process 
shall ensure that any information so disclosed does not 
identify a specific drug manufacturer, provider of services 
or supplier, pharmacy, pharmacy benefit manager, or any 
price charged with respect to a particular drug. 
SEC. 107. 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: 
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‘‘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-
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-
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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— 
‘‘(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 
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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— 
‘‘(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 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 
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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, 
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 
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‘‘(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-
lated to utilization of drug or drug spending 
under that health plan or health insurance cov-
erage during the reporting period; 
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‘‘(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.— 
‘‘(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 
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-
facturers, drug wholesalers, or other direct par-
ticipants in the drug supply chain, in order to 
prevent anti-competitive behavior. 
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‘‘(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.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of the Treasury, shall enforce this section. 
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‘‘(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 
or proceeding under section 1128A of the Social Se-
curity Act. 
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‘‘(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 
(ii) in paragraph (2), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–11)’’ after ‘‘part D’’; and 
(B) in subsection (b)— 
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(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 
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-
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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— 
‘‘(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, 
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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; 
‘‘(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; 
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‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; 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; 
‘‘(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 
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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-
cluded on the formulary of such plan or 
coverage— 
‘‘(I) the amount received, or ex-
pected to be received, from drug man-
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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 
beneficiaries, after manufacturer re-
bates, fees, and other remuneration 
for drugs dispensed within such thera-
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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-
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. 
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‘‘(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 
services on behalf of a group health plan from 
placing reasonable restrictions on the public dis-
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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, 
in accordance with the privacy requirements under 
paragraph (2), the disclosure and redisclosure stand-
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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)— 
(I) in paragraph (6), by striking 
‘‘or (9)’’ and inserting ‘‘(9), or (13)’’; 
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(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 
entity providing pharmacy benefits management 
services that violates section 726(a) or fails to 
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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-
come Security Act of 1974 (29 U.S.C. 1001 et seq.) 
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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 
plan shall submit to the plan sponsor (as defined in 
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