‘‘(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 for the referral of the group 
health plan’s business to the pharmacy benefits 
manager. 
‘‘(2) PRIVACY
REQUIREMENTS.—Entities pro-
viding pharmacy benefits management services on 
behalf of a group health plan shall provide informa-
tion under paragraph (1) in a manner consistent 
with the privacy, security, and breach notification 
regulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
of 1996, and shall restrict the use and disclosure of 
such information according to such privacy regula-
tions. 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
‘‘(B) CLARIFICATION REGARDING PUBLIC 
DISCLOSURE
OF
INFORMATION.—Nothing in 
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this section prevents an entity providing phar-
macy benefits management services on behalf of 
a group health plan from placing reasonable re-
strictions on the public disclosure of the infor-
mation contained in a report described in para-
graph (1), except that such entity may not re-
strict disclosure of such report to the Depart-
ment of Health and Human Services, the De-
partment 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 group health plan, 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 plan, 
and other such reports as requested, in accordance 
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kjohnson on DSK79L0C42PROD with BILLS
with the privacy requirements under paragraph (2), 
the disclosure and redisclosure standards under 
paragraph (3), the standards specified pursuant to 
paragraph (5), and such other information that the 
Comptroller General determines necessary to carry 
out the study under section 103(d) of the Health 
Care Price Transparency Act of 2023. 
‘‘(5) STANDARD FORMAT.—Not later than 18 
months after the date of enactment of this section, 
the Secretary shall specify through rulemaking 
standards for 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 group health plan or 
other entity to restrict disclosure to, or otherwise limit the 
access of, the Secretary of the Treasury to a report de-
scribed in subsection (b)(1) or information related to com-
pliance with subsection (a) or (b) by such plan or other 
entity subject to such subsections. 
‘‘(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.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
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kjohnson on DSK79L0C42PROD with BILLS
nal Revenue Code of 1986 is amended by adding at 
the end the following new item: 
‘‘Sec. 9826. Oversight of pharmacy benefits manager services.’’. 
(b) PHSA.—Title XXVII of the Public Health Serv-
ice Act (42 U.S.C. 300gg et seq.) is amended— 
(1) in part D (42 U.S.C. 300gg–111 et seq.), 
by adding at the end the following new section: 
‘‘SEC. 2799A–11. OVERSIGHT OF PHARMACY BENEFITS MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after the date that is 3 years after the date of enactment 
of this section, a group health plan or health insurance 
issuer offering group health insurance coverage, or an en-
tity or subsidiary providing pharmacy benefits manage-
ment services on behalf of such a plan or issuer, shall not 
enter into a contract with a drug manufacturer, dis-
tributor, wholesaler, subcontractor, rebate aggregator, or 
any associated third party that limits the disclosure of in-
formation to plan sponsors 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 the report described in sub-
section (b). 
‘‘(b) ANNUAL REPORT.— 
‘‘(1) IN GENERAL.—With respect to plan years 
beginning on or after the date that is 3 years after 
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kjohnson on DSK79L0C42PROD with BILLS
the date of enactment of this section, for each such 
plan year, a group health plan or health insurance 
issuer offering group health insurance coverage, or 
an entity providing pharmacy benefits management 
services on behalf of such a plan or an issuer, shall 
submit to the plan sponsor (as defined in section 
3(16)(B) of the Employee Retirement Income Secu-
rity Act of 1974) of such plan or coverage a report 
in a machine-readable format. Each such report 
shall include, with respect to such plan or coverage 
provided for such plan year— 
‘‘(A) to the extent feasible, information col-
lected from drug manufacturers (or an entity 
administering copay assistance on behalf of 
such manufacturers) by such plan or issuer (or 
entity or subsidiary providing pharmacy bene-
fits management services on behalf of such plan 
or issuer) on the total amount of copayment as-
sistance dollars paid, or copayment cards ap-
plied, that were funded by the drug manufac-
turer with respect to the participants, bene-
ficiaries, and enrollees in such plan or coverage; 
‘‘(B) a list of each drug covered by such 
plan or coverage that was dispensed during the 
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plan year, including, with respect to each such 
drug during such plan year— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
‘‘(ii) the number of participants, bene-
ficiaries, and enrollees for whom the drug 
was dispensed during the plan year, the 
total number of prescription claims for the 
drug (including original prescriptions and 
refills), and the total number of dosage 
units of the drug dispensed across the plan 
year, disaggregated by dispensing channel 
(such as retail, 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 dosage unit; 
‘‘(iv) the total out-of-pocket spending 
by participants, beneficiaries, and enrollees 
on such drug, including participant, bene-
ficiary, and enrollee spending through co-
payments, coinsurance, and deductibles; 
‘‘(v) for any drug for which gross 
spending of the group health plan or 
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kjohnson on DSK79L0C42PROD with BILLS
health 
insurance 
coverage 
exceeded 
$10,000 during the plan year— 
‘‘(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 the for-
mulary placement of such drug in that 
therapeutic category or class, if appli-
cable; 
‘‘(vi) the amount received, or expected 
to be received, from drug manufacturers in 
rebates, fees, alternative discounts, or 
other remuneration for claims incurred for 
such drug during the plan year; 
‘‘(vii) the total net spending, after de-
ducting rebates, price concessions, alter-
native discounts or other remuneration 
from drug manufacturers, by the health 
plan or health insurance coverage on such 
drug; and 
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kjohnson on DSK79L0C42PROD with BILLS
‘‘(viii) 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, beneficiaries, and en-
rollees, after manufacturer rebates, fees, 
and other remuneration for such drug dis-
pensed during the plan year; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
health plan or health insurance coverage during 
the plan year, and, with respect to each such 
therapeutic category or class of drugs, during 
the plan year— 
‘‘(i) total gross spending by the plan 
or coverage, before manufacturer rebates, 
fees, or other manufacturer remuneration; 
‘‘(ii) the number of participants, bene-
ficiaries, and enrollees who were dispensed 
a drug covered by such plan or coverage in 
that category or class, broken down by 
each such drug (identified by National 
Drug Code); 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
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kjohnson on DSK79L0C42PROD with BILLS
and utilization management (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; and 
‘‘(iv) the total out-of-pocket spending 
by participants, beneficiaries, and enroll-
ees, including participant, beneficiary, and 
enrollee spending through copayments, co-
insurance, and deductibles; 
‘‘(D) total gross spending on prescription 
drugs by the plan or coverage during the plan 
year, before rebates and other manufacturer 
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 plan year; 
‘‘(F) the total net spending on prescription 
drugs by the health plan or health insurance 
coverage during the plan year; and 
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‘‘(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 for the referral of the group 
health plan’s or health insurance issuer’s busi-
ness to the pharmacy benefits manager. 
‘‘(2) PRIVACY REQUIREMENTS.—Health insur-
ance issuers offering group health insurance cov-
erage and entities providing pharmacy benefits man-
agement services on behalf of a group health plan 
shall provide information under paragraph (1) in a 
manner consistent with the privacy, security, and 
breach notification regulations promulgated under 
section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, and shall restrict 
the use and disclosure of such information according 
to such privacy regulations. 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
VerDate Sep 11 2014 
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kjohnson on DSK79L0C42PROD with BILLS
‘‘(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. 
‘‘(4) REPORT TO GAO.—A group health plan or 
health insurance issuer offering group health insur-
ance coverage, or an entity providing pharmacy ben-
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kjohnson on DSK79L0C42PROD with BILLS
therapeutic category or class, if appli-
cable; 
‘‘(vi) the amount received, or expected 
to be received, from drug manufacturers in 
rebates, fees, alternative discounts, or 
other remuneration for claims incurred for 
such drug during the plan year; 
‘‘(vii) the total net spending, after de-
ducting rebates, price concessions, alter-
native discounts or other remuneration 
from drug manufacturers, by the health 
plan or health insurance coverage on such 
drug; and 
‘‘(viii) 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, beneficiaries, and en-
rollees, after manufacturer rebates, fees, 
and other remuneration for such drug dis-
pensed during the plan year; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
health plan or health insurance coverage during 
the plan year, and, with respect to each such 
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