I 
118TH CONGRESS 
1ST SESSION H. R. 4712 
To provide for increased oversight of entities that provide pharmacy benefit 
management services on behalf of group health plans and health insur-
ance coverage. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 18, 2023 
Mrs. HARSHBARGER (for herself and Ms. MANNING) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Ways and Means, and Education and 
the Workforce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To provide for increased oversight of entities that provide 
pharmacy benefit management services on behalf of 
group health plans and health insurance coverage. 
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 ‘‘Patient Right to Shop 
Act’’. 
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SEC. 2. PROHIBITION ON BLOCKING CONSUMER DECISION- 
SUPPORT TOOLS. 
(a) PHSA.—Part D of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–111 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 2799A–11. PROHIBITION ON BLOCKING CONSUMER 
DECISION-SUPPORT TOOLS. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group or individual health insur-
ance coverage shall not enter into a contract with an entity 
that provides pharmacy benefit management services with 
respect to such plan or coverage if such contract includes 
any terms, conditions, or costs that would prevent or re-
strict a covered third party from accessing or using infor-
mation, for purposes of the consumer decision-support 
tool, relevant to the operability, implementation, and utili-
zation of the consumer-decision support tool regarding 
prescription drug benefits under the plan or coverage that 
are administered by the entity providing pharmacy benefit 
management services in contract with the plan or issuer. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) CONSUMER
DECISION-SUPPORT
TOOL.— 
The term ‘consumer decision-support tool’ means a 
tool designed to inform enrollees in a group health 
plan or health insurance coverage about all costs to 
the enrollee for prescription drugs covered by the 
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plan or coverage, including out-of-pocket, copay-
ment, and coinsurance responsibility, as well as costs 
to the enrollee, such as purchasing at the cash price 
or purchasing through mail order pharmacy benefits. 
‘‘(2) COVERED THIRD PARTY.—The term ‘cov-
ered third party’ means a third party that is in con-
tract, as a business associate (as defined in section 
160.103 of title 45, Code of Federal Regulations (or 
successor regulations)), with a group health plan or 
a health insurance issuer offering group or indi-
vidual health insurance coverage to provide a con-
sumer decision-support tool. 
‘‘(c) RULES
OF CONSTRUCTION REGARDING PRI-
VACY.— 
‘‘(1) Nothing in this section shall be construed 
to alter existing obligations of a covered entity or 
business associate under the privacy, security, and 
breach notification regulations in parts 160 and 164 
of title 45, Code of Federal Regulations (or suc-
cessor regulations). 
‘‘(2) Nothing in this section shall be construed 
to require a group health plan, a health insurance 
issuer offering group or individual health insurance 
coverage, or an entity providing pharmacy benefit 
management services to share protected health infor-
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mation, as defined in section 160.103 of title 45, 
Code of Federal Regulations (or successor regula-
tions), with a covered third party.’’. 
(b) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185 et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 726. PROHIBITION ON BLOCKING CONSUMER DECI-
SION-SUPPORT TOOLS. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group health insurance coverage 
shall not enter into a contract with an entity that provides 
pharmacy benefit management services with respect to 
such plan or coverage if such contract includes any terms, 
conditions, or costs that would prevent or restrict a cov-
ered third party from accessing or using information, for 
purposes of the consumer decision-support tool, relevant 
to the operability, implementation, and utilization of the 
consumer-decision support tool regarding prescription 
drug benefits under the plan or coverage that are adminis-
tered by the entity providing pharmacy benefit manage-
ment services in contract with the plan or issuer. 
‘‘(b) DEFINITIONS.—In this section: 
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‘‘(1) CONSUMER
DECISION-SUPPORT
TOOL.— 
The term ‘consumer decision-support tool’ means a 
tool designed to inform participants and bene-
ficiaries in a group health plan or health insurance 
coverage about all costs to the participant or bene-
ficiary for prescription drugs covered by the plan or 
coverage, including out-of-pocket, copayment, and 
coinsurance responsibility, as well as costs to the 
participant or beneficiary, such as purchasing at the 
cash price or purchasing through mail order phar-
macy benefits. 
‘‘(2) COVERED THIRD PARTY.—The term ‘cov-
ered third party’ means a third party that is in con-
tract, as a business associate (as defined in section 
160.103 of title 45, Code of Federal Regulations (or 
successor regulations)), with a group health plan or 
a health insurance issuer offering group health in-
surance coverage to provide a consumer decision- 
support tool. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to alter existing obligations of a covered entity or 
business associate under the privacy, security, and 
breach notification regulations in parts 160 and 164 
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of title 45, Code of Federal Regulations (or suc-
cessor regulations). 
‘‘(2) Nothing in this section shall be construed 
to require a group health plan, a health insurance 
issuer offering group health insurance coverage, or 
an entity providing pharmacy benefit management 
services to share protected health information, as de-
fined in section 160.103 of title 45, Code of Federal 
Regulations (or successor regulations), with a cov-
ered third party.’’. 
(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.) 
is amended by inserting after the item relating to 
section 725 the following: 
‘‘Sec. 726. Prohibition on blocking consumer decision-support tools.’’. 
(c) INTERNAL REVENUE CODE.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986, as 
amended by section 2, is further amended by adding 
at the end the following new section: 
‘‘SEC. 9826. PROHIBITION ON BLOCKING CONSUMER DECI-
SION-SUPPORT TOOLS. 
‘‘(a) IN GENERAL.—A group health plan offering 
group health insurance coverage shall not enter into a con-
tract with an entity that provides pharmacy benefit man-
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agement services with respect to such plan if such contract 
includes any terms, conditions, or costs that would prevent 
or restrict a covered third party from accessing or using 
information, for purposes of the consumer decision-sup-
port tool, relevant to the operability, implementation, and 
utilization of the consumer-decision support tool regarding 
prescription drug benefits under the plan that are admin-
istered by the entity providing pharmacy benefit manage-
ment services in contract with the plan. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) CONSUMER
DECISION-SUPPORT
TOOL.— 
The term ‘consumer decision-support tool’ means a 
tool designed to inform participants and bene-
ficiaries in a group health plan about all costs to the 
participant or beneficiary for prescription drugs cov-
ered by the plan, including out-of-pocket, copayment, 
and coinsurance responsibility, as well as costs to 
the participant or beneficiary, such as purchasing at 
the cash price or purchasing through mail order 
pharmacy benefits. 
‘‘(2) COVERED THIRD PARTY.—The term ‘cov-
ered third party’ means a third party that is in con-
tract, as a business associate (as defined in section 
160.103 of title 45, Code of Federal Regulations (or 
successor regulations)), with a group health plan or 
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a health insurance issuer offering group health in-
surance coverage to provide a consumer decision- 
support tool. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) Nothing in this section shall be construed 
to alter existing obligations of a covered entity or 
business associate under the privacy, security, and 
breach notification regulations in parts 160 and 164 
of title 45, Code of Federal Regulations (or suc-
cessor regulations). 
‘‘(2) Nothing in this section shall be construed 
to require a group health plan or an entity providing 
pharmacy benefit management services to share pro-
tected health information, as defined in section 
160.103 of title 45, Code of Federal Regulations (or 
successor regulations), with a covered third party.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of such Code 
is amended by adding at the end the following new 
item: 
‘‘Sec. 9826. Prohibition on blocking consumer decision-support tools.’’. 
(d) APPLICATION.—The amendments made by sub-
sections (a), (b), and (c) shall apply with respect to plan 
years beginning on or after the date that is 2 years after 
the date of enactment of this Act. 
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(e) REGULATIONS.—The Secretary of Health and 
Human Services, the Secretary of Labor, and the Sec-
retary of the Treasury shall jointly promulgate regulations 
to carry out the amendments made by subsections (a), (b), 
and (c), and shall issue draft regulations not later than 
1 year after the date of enactment of this Act. 
Æ 
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