I 
115TH CONGRESS 
2D SESSION 
H. R. 6641 
To amend title XXVII of the Public Health Service Act and title XVIII 
of the Social Security Act to prohibit health insurance issuers, group 
health plans, Medicare Advantage organizations, and prescription drug 
plan sponsors from limiting drug price information a pharmacy may 
give to a consumer. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2018 
Mr. PAULSEN (for himself and Ms. ESHOO) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XXVII of the Public Health Service Act 
and title XVIII of the Social Security Act to prohibit 
health insurance issuers, group health plans, Medicare 
Advantage organizations, and prescription drug plan 
sponsors from limiting drug price information a phar-
macy may give to a consumer. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘True Cost-sharing Of 
Seniors’ drugs Transparency Act’’ or the ‘‘COST Act’’. 
SEC. 
2. 
PROHIBITING 
HEALTH 
INSURANCE 
ISSUERS, 
GROUP HEALTH PLANS, MEDICARE ADVAN-
TAGE ORGANIZATIONS, AND PRESCRIPTION 
DRUG 
PLAN 
SPONSORS 
FROM 
LIMITING 
DRUG PRICE INFORMATION A PHARMACY 
MAY GIVE TO A CONSUMER. 
(a) HEALTH
INSURANCE
ISSUERS
AND
GROUP 
HEALTH PLANS.—The first subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–11 et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 2729. PROHIBITION ON PROVISIONS RELATING TO 
THE COMMUNICATION OF CERTAIN PRE-
SCRIPTION DRUG PRICE INFORMATION. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage may not, with respect to plan years begin-
ning after the date the Secretary makes a determination 
specified in subsection (c), prohibit a pharmacy from dis-
closing, or penalize such pharmacy (including through in-
creased utilization review, reduced payments, or other fi-
nancial disincentives) for disclosing, to an individual pur-
chasing a prescription drug using benefits provided under 
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such plan or such coverage alternative methods of pur-
chasing such drug, including paying a cash price, that may 
be cheaper than paying the price of a drug using such 
benefits. 
‘‘(b) CONSUMER INFORMATION.— 
‘‘(1) IN GENERAL.—A group health plan and a 
health insurance issuer offering group or individual 
health insurance coverage shall ensure that, in the 
case that an applicable pharmacy (as defined in 
paragraph (2)) informs an individual with health 
benefits under such plan or such coverage of alter-
native methods of purchasing a drug, including pay-
ing a cash price, that may be cheaper than paying 
the price of a drug using such benefits, such phar-
macy also— 
‘‘(A) informs such individual of— 
‘‘(i) the effect so purchasing such 
drug would have on such individual’s de-
ductible with respect to such plan or such 
coverage; and 
‘‘(ii) other information determined ap-
propriate by the Secretary for purposes of 
enabling such individual to make an in-
formed decision with respect to the effects 
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of using such benefits or such alternative 
methods to purchase such drug; and 
‘‘(B) in the case that such individual pur-
chases such drug using such alternative meth-
ods, reports to such plan or such issuer the 
amount such individual paid for such drug 
using such alternative methods. 
‘‘(2) DEFINITION.—In this subsection, the term 
‘applicable pharmacy’ means, with respect to a 
group health plan and a health insurance issuer of-
fering group or individual health insurance coverage, 
a pharmacy with which such plan or such issuer con-
tracts with under such plan or such coverage or that 
is otherwise an in-network pharmacy under such 
plan or such coverage. 
‘‘(c) DETERMINATION.—A determination specified in 
this subsection is a determination by the Secretary that 
a prohibition or penalty described in subsection (a) is 
being used by a group health plan or a health insurance 
issuer offering group or individual health insurance cov-
erage.’’. 
(b) MA ORGANIZATIONS AND PDP SPONSORS.—Sec-
tion 1860D–4 of the Social Security Act (42 U.S.C. 
1395w–104) is amended by adding at the end the fol-
lowing new subsection: 
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‘‘(m) PROHIBITION ON LIMITING CERTAIN INFORMA-
TION ON PRESCRIPTION DRUG PRICES.— 
‘‘(1) IN GENERAL.—A PDP sponsor of a pre-
scription drug plan and a Medicare Advantage orga-
nization offering an MA–PD plan may not, with re-
spect to plan years beginning after the date the Sec-
retary makes a determination specified in paragraph 
(3), prohibit a pharmacy from disclosing, or penalize 
such pharmacy (including through increased utiliza-
tion review, reduced payments, or other financial 
disincentives) for disclosing, to an individual pur-
chasing a prescription drug using benefits provided 
under such prescription drug plan or such MA–PD 
plan alternative methods of purchasing such drug, 
including paying a cash price, that may be cheaper 
than paying the price of a drug using such benefits. 
‘‘(2) CONSUMER INFORMATION.— 
‘‘(A) IN GENERAL.—A PDP sponsor of a 
prescription drug plan and a Medicare Advan-
tage organization offering an MA–PD plan 
shall ensure that, in the case that an applicable 
pharmacy (as defined in subparagraph (B)) in-
forms an individual with health benefits under 
such prescription drug plan or such MA–PD 
plan of alternative methods of purchasing a 
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drug, including paying a cash price, that may 
be cheaper than paying the price of a drug 
using such benefits, such pharmacy also— 
‘‘(i) informs such individual of— 
‘‘(I) the effect so purchasing such 
drug would have on such individual’s 
deductible with respect to such pre-
scription drug plan or such MA–PD 
plan; and 
‘‘(II) other information deter-
mined appropriate by the Secretary 
for purposes of enabling such indi-
vidual to make an informed decision 
with respect to the effects of using 
such benefits or such alternative 
methods to purchase such drug; and 
‘‘(ii) in the case that such individual 
purchases such drug using such alternative 
methods, reports to such sponsor or such 
organization the amount such individual 
paid for such drug using such alternative 
methods. 
‘‘(B) DEFINITION.—For purposes of this 
paragraph, the term ‘applicable pharmacy’ 
means, with respect to a PDP sponsor of a pre-
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scription drug plan and a Medicare Advantage 
organization offering an MA–PD plan, a phar-
macy with which such sponsor or such organi-
zation contracts with under such prescription 
drug plan or such MA–PD plan or that is oth-
erwise an in-network pharmacy under such pre-
scription drug plan or such MA–PD plan. 
‘‘(3) DETERMINATION.—A determination speci-
fied in this paragraph is a determination by the Sec-
retary that a prohibition or penalty described in 
paragraph (1) is being used by a PDP sponsor of a 
prescription drug plan or a Medicare Advantage or-
ganization offering an MA–PD plan with respect to 
such prescription drug plan or MA–PD plan.’’. 
(c) STUDY OF PREVALENCE OF PHARMACY PROVI-
SION OF INFORMATION PROHIBITIONS.—Not later than 1 
year after the date of the enactment of this Act, the Sec-
retary of Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’) shall conduct a study and 
submit to Congress a report on the prevalence of prohibi-
tions by— 
(1) group health plans and health insurance 
issuers (as such terms are defined in section 2791 
of the Public Health Service Act (42 U.S.C. 300gg– 
91)); and 
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