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 administrators who are drug 
manufacturers, drug wholesalers, or other direct 
participants 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 ad-
ministrator under paragraph (1) with respect to 
such coverage or plan, and other such reports as re-
quested, in accordance with the privacy requirements 
under paragraph (2), the disclosure and redisclosure 
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standards under paragraph (3), the standards speci-
fied pursuant to paragraph (5). 
‘‘(5) STANDARD
FORMAT.—Not later than 6 
months after the date of enactment of this section, 
the Secretary shall specify through rulemaking 
standards for health insurance issuers and entities 
required to submit reports under paragraph (4) to 
submit such reports in a standard format. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) FAILURE TO PROVIDE TIMELY INFORMA-
TION.—An entity providing pharmacy benefits man-
agement services that violates subsection (a) or fails 
to provide information required under subsection (b) 
shall be subject to a civil monetary penalty in the 
amount of $10,000 for each day during which such 
violation continues or such information is not dis-
closed or reported. 
‘‘(2) FALSE
INFORMATION.—An entity pro-
viding pharmacy benefits management services that 
knowingly provides false information under this sec-
tion 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. 
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‘‘(3) 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. 
‘‘(4) WAIVERS.—The Secretary may waive pen-
alties under paragraph (2), or extend the period of 
time for compliance with a requirement of this sec-
tion, for an entity in violation of this section that 
has made a good-faith effort to comply with this 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) DEFINITIONS.—In this section: 
‘‘(1) LARGE EMPLOYER.—The term ‘large em-
ployer’ means, in connection with a group health 
plan with respect to a calendar year and a plan year, 
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an employer who employed an average of at least 50 
employees on business days during the preceding 
calendar year and who employs at least 1 employee 
on the first day of the plan year. 
‘‘(2) WHOLESALE
ACQUISITION
COST.—The 
term ‘wholesale acquisition cost’ has the meaning 
given such term in section 1847A(c)(6)(B) of the 
Social Security Act.’’. 
(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 new section: 
‘‘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 may not enter into a 
contract with a drug manufacturer, distributor, whole-
saler, switch, patient or copay assistance program admin-
istrator, pharmacy, subcontractor, rebate aggregator, or 
any associated third party that limits or delays the disclo-
sure of information to plan administrators in such a man-
ner that prevents the plan, or an entity or subsidiary pro-
viding pharmacy benefits management services on behalf 
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of a plan, from making or substantiating the reports de-
scribed in subsection (b). 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2025, not less frequently 
than quarterly (and upon request by the plan admin-
istrator), a group health plan, or an entity providing 
pharmacy benefits management services on behalf of 
a group health plan, shall submit to the plan admin-
istrator (as defined in section 3(16)(A) of the Em-
ployee Retirement Income Security Act of 1974) of 
such plan a report in accordance with this sub-
section, and make such report available to the plan 
administrator in a machine-readable format (or as 
may be determined by the Secretary, other formats). 
Each such report shall include, with respect to the 
applicable group health plan— 
‘‘(A) information collected from a patient 
or copay assistance program administrator by 
such entity on the total amount of copayment 
assistance dollars paid, or copayment cards ap-
plied, or other discounts that were funded by 
the drug manufacturer with respect to the par-
ticipants and beneficiaries in such plan; 
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‘‘(B) total gross spending on prescription 
drugs by the plan during the reporting period; 
‘‘(C) total amount received, or expected to 
be received, by the plan from any entities, in re-
bates, fees, alternative discounts, and all other 
remuneration received from the entity or any 
third party (including group purchasing organi-
zations) other than the plan administrator, re-
lated to utilization of drug or drug spending 
under such plan during the reporting period; 
‘‘(D) the total net spending on prescription 
drugs by the plan during such reporting period; 
‘‘(E) amounts paid, directly or indirectly, 
in rebates, fees, or any other type of compensa-
tion 
(as 
defined 
in 
section 
408(b)(2)(B)(ii)(dd)(AA) of the Employee Re-
tirement Income Security Act of 1974) to bro-
kerage houses, brokers, consultants, advisors, or 
any other individual or firm for the referral of 
the group health plan’s business to the phar-
macy benefits manager, identified by the recipi-
ent of such amounts; 
‘‘(F)(i) an explanation of any benefit de-
sign parameters that encourage or require par-
ticipants and beneficiaries in the plan to fill 
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prescriptions at mail order, specialty, or retail 
pharmacies that are affiliated with or under 
common ownership with the entity providing 
pharmacy benefit management services under 
such plan, including mandatory mail and spe-
cialty home delivery programs, retail and mail 
auto-refill programs, and cost-sharing assist-
ance incentives funded by an entity providing 
pharmacy benefit management services; 
‘‘(ii) the percentage of total prescrip-
tions charged to the plan, or participants 
and beneficiaries in such plan, that were 
dispensed by mail order, specialty, or retail 
pharmacies that are affiliated with or 
under common ownership with the entity 
providing pharmacy benefit management 
services; and 
‘‘(iii) a list of all drugs dispensed by 
such affiliated pharmacy or pharmacy 
under common ownership and charged to 
the plan, or participants and beneficiaries 
of the plan, during the applicable period, 
and, with respect to each drug— 
‘‘(I)(aa) the amount charged, per 
dosage unit, per 30-day supply, and 
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per 90-day supply, with respect to 
participants and beneficiaries in the 
plan, to the plan; and 
‘‘(bb) the amount charged, 
per dosage unit, per 30-day sup-
ply, and per 90-day supply, to 
participants and beneficiaries; 
‘‘(II) the median amount charged 
to the plan, per dosage unit, per 30- 
day supply, and per 90-day supply, in-
cluding amounts paid by the partici-
pants and beneficiaries, when the 
same drug is dispensed by other phar-
macies that are not affiliated with or 
under common ownership with the en-
tity and that are included in the phar-
macy network of such plan; 
‘‘(III) the interquartile range of 
the costs, per dosage unit, per 30-day 
supply, and per 90-day supply, includ-
ing amounts paid by the participants 
and beneficiaries, when the same drug 
is dispensed by other pharmacies that 
are not affiliated with or under com-
mon ownership with the entity and 
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that are included in the pharmacy 
network of that plan; 
‘‘(IV) the lowest cost, per dosage 
unit, per 30-day supply, and per 90- 
day supply, for such drug, including 
amounts charged to the plan and par-
ticipants and beneficiaries, that is 
available from any pharmacy included 
in the network of the plan; 
‘‘(V) the net acquisition cost per 
dosage unit, per 30-day supply, and 
per 90-day supply, if the drug is sub-
ject to a maximum price discount; and 
‘‘(VI) other information with re-
spect to the cost of the drug, as deter-
mined by the Secretary, such as aver-
age sales price, wholesale acquisition 
cost, and national average drug acqui-
sition cost per dosage unit or per 30- 
day supply, and per-90 day supply, 
for such drug, including amounts 
charged to the plan and participants 
and beneficiaries among all phar-
macies included in the network of 
such plan; and 
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‘‘(G) in the case of a large employer— 
‘‘(i) a list of each drug covered by 
such plan or entity providing pharmacy 
benefits management services for which a 
claim was filed during the reporting period, 
including, with respect to each such drug 
during the reporting period— 
‘‘(I) the brand name, generic or 
non-proprietary name, and the Na-
tional Drug Code; 
‘‘(II)(aa) the number of partici-
pants and beneficiaries for whom a 
claim for such drug was filed during 
the reporting period, the total number 
of prescription claims for such drug 
(including original prescriptions and 
refills), and the total number of dos-
age units and total days supply of 
such drug for which a claim was filed 
during the reporting period; and 
‘‘(bb) with respect to each 
claim or dosage unit described in 
item (aa), the type of dispensing 
channel used, such as retail, mail 
order, or specialty pharmacy; 
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‘‘(III) the wholesale acquisition 
cost, listed as cost per days supply 
and cost per dosage unit on date of 
dispensing; 
‘‘(IV) 
the 
total 
out-of-pocket 
spending by participants and bene-
ficiaries on such drug after applica-
tion of any benefits under such plan, 
including participant and beneficiary 
spending through copayments, coin-
surance, and deductibles (but not in-
cluding any amounts spent by partici-
pants and beneficiaries on drugs not 
covered under such plan, or for which 
no claim was submitted to such plan); 
‘‘(V) for any drug for which 
gross spending of the plan exceeded 
$10,000 during the reporting period— 
‘‘(aa) a list of all other 
drugs in the same therapeutic 
category or class, including brand 
name drugs, biological products, 
generic drugs, or biosimilar bio-
logical products that are in the 
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same therapeutic category or 
class as such drug; and 
‘‘(bb) the rationale for pre-
ferred formulary placement of 
such drug in that therapeutic 
category or class, if applicable; 
and 
‘‘(ii) a list of each therapeutic cat-
egory or class of drugs for which a claim 
was filed under the plan during the report-
ing period, and, with respect to each such 
therapeutic category or class of drugs dur-
ing the reporting period— 
‘‘(I) total gross spending by the 
plan; 
‘‘(II) the number of participants 
and beneficiaries who filled a prescrip-
tion for a drug in that category or 
class; 
‘‘(III) if applicable to that cat-
egory or class, a description of the 
formulary tiers and utilization mecha-
nisms (such as prior authorization or 
step therapy) employed for drugs in 
that category or class; 
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