Title: True Cost-sharing Of Seniors' drugs Transparency Act
Policy area: Health

Summary:
True Cost-sharing Of Seniors' drugs Transparency Act or the COST Act
This bill prohibits health insurers from restricting the ability of pharmacies to inform enrollees of alternative and cheaper payment methods for prescription drugs.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6641 Introduced in House (IH)]

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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 
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 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.

    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 ``True Cost-sharing Of Seniors' drugs 
Transparency Act'' or the ``COST Act''.

SEC. 2. PROHIBITING 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.

    (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 PRESCRIPTION DRUG PRICE INFORMATION.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not, 
with respect to plan years beginning after the date the Secretary makes 
a determination specified in subsection (c), prohibit a pharmacy from 
disclosing, or penalize such pharmacy (including through increased 
utilization review, reduced payments, or other financial disincentives) 
for disclosing, to an individual purchasing a prescription drug using 
benefits provided under such plan or such coverage 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.
    ``(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 
        alternative methods of purchasing a drug, including paying a 
        cash price, that may be cheaper than paying the price of a drug 
        using such benefits, such pharmacy also--
                    ``(A) informs such individual of--
                            ``(i) the effect so purchasing such drug 
                        would have on such individual's deductible with 
                        respect to such plan or such coverage; and
                            ``(ii) other information determined 
                        appropriate by the Secretary for purposes of 
                        enabling such individual to make an informed 
                        decision with respect to the effects of using 
                        such benefits or such alternative methods to 
                        purchase such drug; and
                    ``(B) in the case that such individual purchases 
                such drug using such alternative methods, 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 offering group or individual health 
        insurance coverage, a pharmacy with which such plan or such 
        issuer contracts 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 
coverage.''.
    (b) MA Organizations and PDP Sponsors.--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 Prescription 
Drug Prices.--
            ``(1) In general.--A PDP sponsor of a prescription drug 
        plan and a Medicare Advantage organization offering an MA-PD 
        plan may not, with respect to plan years beginning after the 
        date the Secretary makes a determination specified in paragraph 
        (3), prohibit a pharmacy from disclosing, or penalize such 
        pharmacy (including through increased utilization review, 
        reduced payments, or other financial disincentives) for 
        disclosing, to an individual purchasing 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 Advantage organization 
                offering an MA-PD plan shall ensure that, in the case 
                that an applicable pharmacy (as defined in subparagraph 
                (B)) informs an individual with health benefits under 
                such prescription drug plan or such MA-PD plan of 
                alternative methods of purchasing a 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 
                                prescription drug plan or such MA-PD 
                                plan; and
                                    ``(II) other information determined 
                                appropriate by the Secretary for 
                                purposes of enabling such individual 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 prescription drug plan and a Medicare 
                Advantage organization offering an MA-PD plan, a 
                pharmacy with which such sponsor or such organization 
                contracts with under such prescription drug plan or 
                such MA-PD plan or that is otherwise an in-network 
                pharmacy under such prescription drug plan or such MA-
                PD plan.
            ``(3) Determination.--A determination specified in this 
        paragraph is a determination by the Secretary 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 organization offering an MA-PD plan with respect to 
        such prescription drug plan or MA-PD plan.''.
    (c) Study of Prevalence of Pharmacy Provision of Information 
Prohibitions.--Not later than 1 year after the date of the enactment of 
this Act, the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall conduct a study and submit to 
Congress a report on the prevalence of prohibitions 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
            (2) MA organizations offering MA-PD plans and sponsors of 
        prescription drug plans;
on pharmacies from disclosing alternative prices of a drug to an 
individual purchasing such drug at such pharmacy using benefits under 
such group health plan, such health insurance coverage, such MA-PD 
plan, or such prescription drug plan (as applicable).
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