Title: Know the Cost Act of 2018
Policy area: Health

Summary:
Know the Cost Act of 2018
This bill prohibits a health insurance plan or pharmacy benefits manager from restricting a pharmacy from informing an enrollee of any difference between the cost of a drug under the plan and the cost of the drug without health insurance coverage. (Such restrictions are commonly referred to as gag clauses.)

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6733 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6733

 To amend title XXVII of the Public Health Service Act and title XVIII 
   of the Social Security Act to prohibit group health plans, health 
   insurance issuers, prescription drug plan sponsors, and Medicare 
   Advantage organizations from limiting certain information on drug 
                                prices.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 7, 2018

   Mr. Carter of Georgia (for himself, Mr. Paulsen, Mr. Doggett, Mr. 
 Welch, Mrs. McMorris Rodgers, Ms. Eshoo, Mr. Griffith, Mrs. Dingell, 
  Mr. Burgess, and Mr. Gene Green of Texas) 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 
subsequently 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 group health plans, health 
   insurance issuers, prescription drug plan sponsors, and Medicare 
   Advantage organizations from limiting certain information on drug 
                                prices.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Know the Cost Act of 2018''.

SEC. 2. PROHIBITION ON LIMITING CERTAIN INFORMATION ON DRUG PRICES.

    (a) In General.--
            (1) Group health plans and health insurance issuers.--
        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:

``SEC. 2729. INFORMATION ON PRESCRIPTION DRUGS.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage shall--
            ``(1) not restrict, directly or indirectly, any pharmacy 
        that dispenses a prescription drug to an enrollee in the plan 
        or coverage from informing (or penalize such pharmacy for 
        informing) an enrollee of any differential between the 
        enrollee's out-of-pocket cost under the plan or coverage with 
        respect to acquisition of the drug and the amount an individual 
        would pay for acquisition of the drug without using any health 
        plan or health insurance coverage; and
            ``(2) ensure that any entity that provides pharmacy 
        benefits management services under a contract with any such 
        health plan or health insurance coverage does not, with respect 
        to such plan or coverage, restrict, directly or indirectly, a 
        pharmacy that dispenses a prescription drug from informing (or 
        penalize such pharmacy for informing) an enrollee of any 
        differential between the enrollee's out-of-pocket cost under 
        the plan or coverage with respect to acquisition of the drug 
        and the amount an individual would pay for acquisition of the 
        drug without using any health plan or health insurance 
        coverage.
    ``(b) Definition.--For purposes of this section, the term `out-of-
pocket cost', with respect to acquisition of a drug, means the amount 
to be paid by the enrollee under the plan or coverage, including any 
cost-sharing (including any deductible, copayment, or coinsurance) and, 
as determined by the Secretary, any other expenditure.''.
            (2) Prescription drug plan sponsors and medicare advantage 
        organizations.--Section 1860D-4 of the Social Security Act (42 
        U.S.C. 1395w-104) is amended by adding at the end the following 
        new subsection:
    ``(m) Prohibition on Limiting Certain Information on Drug Prices.--
A PDP sponsor and a Medicare Advantage organization shall ensure that 
each prescription drug plan or MA-PD plan offered by the sponsor or 
organization does not restrict a pharmacy that dispenses a prescription 
drug or biological from informing, nor penalize such pharmacy for 
informing, an enrollee in such plan of any differential between the 
negotiated price of, or copayment or coinsurance for, the drug or 
biological to the enrollee under the plan and a lower price the 
individual would pay for the drug or biological if the enrollee 
obtained the drug without using any health insurance coverage.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2020.
    (b) Medicare Beneficiary Notice Requirements.--
            (1) Annual notice requirement.--Section 1804(c) of the 
        Social Security Act (42 U.S.C. 1395b-2(c)) is amended--
                    (A) in paragraph (3), by striking ``and'' at the 
                end;
                    (B) in paragraph (4), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(5) with respect to a notice provided on or after January 
        1, 2020, and an individual enrolled in a prescription drug plan 
        under part D or an MA-PD plan under part C, information on the 
        potential effects purchasing a drug without using benefits 
        provided under such prescription drug plan or MA-PD plan may 
        have on such individual's deductible and future cost-sharing 
        obligations under such prescription drug plan or MA-PD plan.''.
            (2) MA organization and pdp sponsor disclosures.--
                    (A) In general.--Section 1852(c)(1) of the Social 
                Security Act (42 U.S.C. 1395w-22(c)(1)) is amended by 
                adding at the end the following new subparagraph:
                    ``(J) Drug purchasing information.--With respect to 
                an enrollee in an MA-PD plan, information in a form and 
                manner specified by the Secretary on the potential 
                effects purchasing a drug without using benefits 
                provided under such plan may have on such individual's 
                deductible and future cost-sharing obligations under 
                such plan.''.
                    (B) Effective date.--The amendment made by this 
                paragraph shall apply with respect to disclosures made 
                on or after January 1, 2020.
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