I 
118TH CONGRESS 
1ST SESSION H. R. 2816 
To amend title XI of the Social Security Act to strengthen transparency 
requirements with respect to pharmacy benefit managers. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 25, 2023 
Mrs. HARSHBARGER (for herself, Ms. SPANBERGER, Mrs. MILLER-MEEKS, 
and Mr. KRISHNAMOORTHI) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined 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 XI of the Social Security Act to strengthen 
transparency requirements with respect to pharmacy ben-
efit managers. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Pharmacy Benefit 
Manager Sunshine and Accountability Act’’. 
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SEC. 2. STRENGTHENING PHARMACY BENEFIT MANAGER 
TRANSPARENCY REQUIREMENTS. 
Section 1150A of the Social Security Act (42 U.S.C. 
1320b–23) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by striking ‘‘; or’’ 
and inserting a semicolon; 
(B) in paragraph (2), by striking the 
comma at the end and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(3) a group health plan or health insurance 
issuer offering group or individual health insurance 
coverage (as such terms are defined in section 2791 
of the Public Health Service Act),’’; 
(2) by amending subsection (b) to read as fol-
lows: 
‘‘(b) INFORMATION DESCRIBED.—The information 
described in this subsection is the following with respect 
to services provided by a health benefits plan or PBM for 
a contract year: 
‘‘(1) With respect to a contract with each entity 
described in paragraphs (1) through (3) of sub-
section (a), the aggregate dollar amount of all— 
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‘‘(A) rebates that a PBM or health bene-
fits plan received under each such contract 
from all drug manufacturers; 
‘‘(B) administrative fees that a PBM or 
health benefits plan received under each such 
contract with from all drug manufacturers; 
‘‘(C) administrative fees that a PBM or 
health benefits plan received under each con-
tract from each such entity; 
‘‘(D) rebates that a PBM or health bene-
fits plan received under each contract with each 
entity from all pharmaceutical manufacturers 
that were not passed through to such entities; 
‘‘(E) administrative fees that a PBM or 
health benefits plan received under each con-
tract from all pharmaceutical manufacturers 
and did not pass through to such entities; 
‘‘(F) total post-claim adjudication pay-
ments that a PBM or health benefits plan col-
lected from a pharmacy under each contract, 
including any fees, reimbursements, or other 
claw backs including generic effective rate and 
brand effective rate contracts; and 
‘‘(G) any post-claim adjudication payments 
that a PBM or health benefits plan collected 
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from a pharmacy under each contract, including 
any fees, reimbursements, or other claw backs 
including generic effective rate and brand effec-
tive rate contracts that were not passed through 
to such entities. 
‘‘(2) The aggregate retained rebate percentage 
under each contract (that is the value in paragraph 
(1)(D) divided by the value in paragraph (1)(A)). 
‘‘(3) Across all contractual relationships for 
each PBM whereby such PBM is managing prescrip-
tion drug coverage for a entity described in in para-
graphs (1) through (3) of subsection (a), the highest 
retained rebate percentage and lowest retained re-
bate percentage for each contract under which such 
PBM provided services.’’; 
(3) in subsection (c)— 
(A) in the matter preceding paragraph (1), 
by striking ‘‘, plan, or prices charged for 
drugs,’’ and inserting ‘‘or plan, the prices 
charged for a specific drug or classes of drugs, 
or the amount of any rebates provided for a 
specific drug or classes of drugs,’’; and 
(B) by adding at the end the following new 
paragraph: 
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‘‘(5) To carry out the reporting requirement 
under subsection (e).’’; and 
(4) by adding at the end the following new sub-
sections: 
‘‘(e) PUBLIC REPORTING REQUIREMENT.—Not later 
than the first calendar quarter following the first full plan 
year beginning on or after the date of enactment of this 
subsection, and annually thereafter, the Secretary shall 
publish on a public website of the Department of Health 
and Human Services the information reported under sub-
section (b), in accordance with the confidentiality require-
ments described in subsection (c). 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) BRAND
EFFECTIVE
RATE.—The term 
‘brand effective rate’ means the claim reimburse-
ment for a brand name drug, expressed as a per-
centage discount from the average wholesale price of 
such drug. 
‘‘(2) GENERIC
EFFECTIVE
RATE.—The term 
‘generic effective rate’ means the claim reimburse-
ment for a generic drug, expressed as a percentage 
discount from the average wholesale price of such 
drug. 
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‘‘(3) PHARMACY
BENEFITS
MANAGER.—The 
term ‘pharmacy benefits manager’ or ‘PBM’ 
means— 
‘‘(A) an entity that manages prescription 
drug benefits on behalf of an entity described in 
paragraphs (1) through (3) of subsection (a); 
and 
‘‘(B) for purposes of this section, includes 
any other organization that— 
‘‘(i) has directly or indirectly (as de-
termined by the Secretary in regulations), 
an ownership interest of 5 percent or more 
in the PBM; 
‘‘(ii) shares, or is otherwise a part of, 
the same organizational structure as the 
PBM; 
‘‘(iii) exercises operational, financial, 
or managerial control over the PBM or a 
part thereof, or provides policies or proce-
dures for any of the operations of the 
PBM, or provides financial or cash man-
agement services to the PBM; or 
‘‘(iv) provides management or admin-
istrative services, management or clinical 
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consulting services, or accounting or finan-
cial services to the PBM. 
‘‘(4) ORGANIZATIONAL STRUCTURE.—The term 
‘organizational structure’ means, in the case of— 
‘‘(A) a corporation, the officers, directors, 
and shareholders of the corporation who have 
an ownership interest in the corporation which 
is equal to or exceeds 5 percent; 
‘‘(B) a limited liability company, the mem-
bers and managers of the limited liability com-
pany; 
‘‘(C) a general partnership, the partners of 
the general partnership; 
‘‘(D) a limited partnership, the general 
partners and any limited partners of the limited 
partnership who have an ownership interest in 
the limited partnership which is equal to or ex-
ceeds 5 percent; 
‘‘(E) a trust, the trustees of the trust; or 
‘‘(F) any other person or entity as the Sec-
retary determines appropriate.’’. 
Æ 
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