Title: A bill to increase transparency and access to group health plan and health insurance issuer reporting, and for other purposes.
Policy area: Health

Summary:
This bill requires health insurers to report information about their plans, including costs related to prescription drugs, spending on health care services, and average monthly premiums.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4959 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 4959

  To increase transparency and access to group health plan and health 
               issuer reporting, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 3, 2020

   Mr. Braun introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To increase transparency and access to group health plan and health 
               issuer reporting, and for other purposes.

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

SECTION 1. REPORTING ON PHARMACY BENEFITS AND DRUG COSTS.

    (a) PSHA.--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. 2729A. REPORTING ON PHARMACY BENEFITS AND DRUG COSTS.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this section, and not later than March 1 of each year 
thereafter, a group health plan or health insurance issuer offering 
group or individual health insurance coverage (except for a church 
plan) shall submit to the Secretary, the Secretary of Labor, and the 
Secretary of the Treasury the following information with respect to the 
health plan or coverage in the previous plan year:
            ``(1) The beginning and end dates of the plan year.
            ``(2) The number of enrollees.
            ``(3) Each State in which the plan or coverage is offered.
            ``(4) The 50 brand prescription drugs most frequently 
        dispensed by pharmacies for claims paid by the plan or 
        coverage, and the total number of paid claims for each such 
        drug.
            ``(5) The 50 most costly prescription drugs with respect to 
        the plan or coverage by total annual spending, and the annual 
        amount spent by the plan or coverage for each such drug.
            ``(6) The 50 prescription drugs with the greatest increase 
        in plan expenditures over the plan year preceding the plan year 
        that is the subject of the report, and, for each such drug, the 
        change in amounts expended by the plan or coverage in each such 
        plan year.
            ``(7) Total spending on health care services by such group 
        health plan or health insurance coverage, broken down by--
                    ``(A) the type of costs, including--
                            ``(i) hospital costs;
                            ``(ii) health care provider and clinical 
                        service costs, for primary care and specialty 
                        care separately;
                            ``(iii) costs for prescription drugs; and
                            ``(iv) other medical costs, including 
                        wellness services; and
                    ``(B) spending on prescription drugs by--
                            ``(i) the health plan or coverage; and
                            ``(ii) the enrollees.
            ``(8) The average monthly premium--
                    ``(A) paid by employers on behalf of enrollees, as 
                applicable; and
                    ``(B) paid by enrollees.
            ``(9) Any impact on premiums by rebates, fees, and any 
        other remuneration paid by drug manufacturers to the plan or 
        coverage or its administrators or service providers, with 
        respect to prescription drugs prescribed to enrollees in the 
        plan or coverage, including--
                    ``(A) the amounts so paid for each therapeutic 
                class of drugs; and
                    ``(B) the amounts so paid for each of the 25 drugs 
                that yielded the highest amount of rebates and other 
                remuneration under the plan or coverage from drug 
                manufacturers during the plan year.
            ``(10) Any reduction in premiums and out-of-pocket costs 
        associated with rebates, fees, or other remuneration described 
        in paragraph (9).
    ``(b) Report.--Not later than 18 months after the date on which the 
first report is required under subsection (a) and biannually 
thereafter, the Secretary, acting through the Assistant Secretary of 
Planning and Evaluation and in coordination with the Inspector General 
of the Department of Health and Human Services, shall make available on 
the internet website of the Department of Health and Human Services a 
report on prescription drug reimbursements under group health plans and 
group and individual health insurance coverage, prescription drug 
pricing trends, and the role of prescription drug costs in contributing 
to premium increases or decreases under such plans or coverage, 
aggregated in such a way as no drug or plan specific information will 
be made public.
    ``(c) Privacy Protections.--No confidential or trade secret 
information submitted to the Secretary under subsection (a) shall be 
included in the report under subsection (b).''.
    (b) ERISA.--Subpart B of part 7 of subtitle 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:

``SEC. 716. REPORTING ON PHARMACY BENEFITS AND DRUG COSTS.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this section, and not later than March 1 of each year 
thereafter, a group health plan (or health insurance coverage offered 
in connection with such a plan) shall submit to the Secretary, the 
Secretary of Health and Human Services, and the Secretary of the 
Treasury the following information with respect to the health plan or 
coverage in the previous plan year:
            ``(1) The beginning and end dates of the plan year.
            ``(2) The number of participants and beneficiaries.
            ``(3) Each State in which the plan or coverage is offered.
            ``(4) The 50 brand prescription drugs most frequently 
        dispensed by pharmacies for claims paid by the plan or 
        coverage, and the total number of paid claims for each such 
        drug.
            ``(5) The 50 most costly prescription drugs with respect to 
        the plan or coverage by total annual spending, and the annual 
        amount spent by the plan or coverage for each such drug.
            ``(6) The 50 prescription drugs with the greatest increase 
        in plan expenditures over the plan year preceding the plan year 
        that is the subject of the report, and, for each such drug, the 
        change in amounts expended by the plan or coverage in each such 
        plan year.
            ``(7) Total spending on health care services by such group 
        health plan or health insurance coverage, broken down by--
                    ``(A) the type of costs, including--
                            ``(i) hospital costs;
                            ``(ii) health care provider and clinical 
                        service costs, for primary care and specialty 
                        care separately;
                            ``(iii) costs for prescription drugs; and
                            ``(iv) other medical costs, including 
                        wellness services; and
                    ``(B) spending on prescription drugs by--
                            ``(i) the health plan or coverage; and
                            ``(ii) the participants and beneficiaries.
            ``(8) The average monthly premium--
                    ``(A) paid by employers on behalf of participants 
                and beneficiaries, as applicable; and
                    ``(B) paid by participants and beneficiaries.
            ``(9) Any impact on premiums by rebates, fees, and any 
        other remuneration paid by drug manufacturers to the plan or 
        coverage or its administrators or service providers, with 
        respect to prescription drugs prescribed to participants and 
        beneficiaries in the plan or coverage, including--
                    ``(A) the amounts so paid for each therapeutic 
                class of drugs; and
                    ``(B) the amounts so paid for each of the 25 drugs 
                that yielded the highest amount of rebates and other 
                remuneration under the plan or coverage from drug 
                manufacturers during the plan year.
            ``(10) Any reduction in premiums and out-of-pocket costs 
        associated with rebates, fees, or other remuneration described 
        in paragraph (9).
    ``(b) Report.--Not later than 18 months after the date on which the 
first report is required under subsection (a) and biannually 
thereafter, the Secretary, acting in coordination with the Inspector 
General of the Department of Labor, shall make available on the 
internet website of the Department of Labor a report on prescription 
drug reimbursements under group health plans (or health insurance 
coverage offered in connection with such a plan), prescription drug 
pricing trends, and the role of prescription drug costs in contributing 
to premium increases or decreases under such plans or coverage, 
aggregated in such a way as no drug or plan specific information will 
be made public.
    ``(c) Privacy Protections.--No confidential or trade secret 
information submitted to the Secretary under subsection (a) shall be 
included in the report under subsection (b).''.
    (c) IRC.--Subchapter B of chapter 100 of the Internal Revenue Code 
of 1986 is amended by adding at the end the following:

``SEC. 9816. REPORTING ON PHARMACY BENEFITS AND DRUG COSTS.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this section, and not later than March 1 of each year 
thereafter, a group health plan shall submit to the Secretary, the 
Secretary of Health and Human Services, and the Secretary of Labor the 
following information with respect to the health plan in the previous 
plan year:
            ``(1) The beginning and end dates of the plan year.
            ``(2) The number of participants and beneficiaries.
            ``(3) Each State in which the plan is offered.
            ``(4) The 50 brand prescription drugs most frequently 
        dispensed by pharmacies for claims paid by the plan, and the 
        total number of paid claims for each such drug.
            ``(5) The 50 most costly prescription drugs with respect to 
        the plan by total annual spending, and the annual amount spent 
        by the plan for each such drug.
            ``(6) The 50 prescription drugs with the greatest increase 
        in plan expenditures over the plan year preceding the plan year 
        that is the subject of the report, and, for each such drug, the 
        change in amounts expended by the plan in each such plan year.
            ``(7) Total spending on health care services by such group 
        health plan, broken down by--
                    ``(A) the type of costs, including--
                            ``(i) hospital costs;
                            ``(ii) health care provider and clinical 
                        service costs, for primary care and specialty 
                        care separately;
                            ``(iii) costs for prescription drugs; and
                            ``(iv) other medical costs, including 
                        wellness services; and
                    ``(B) spending on prescription drugs by--
                            ``(i) the health plan; and
                            ``(ii) the participants and beneficiaries.
            ``(8) The average monthly premium--
                    ``(A) paid by employers on behalf of participants 
                and beneficiaries, as applicable; and
                    ``(B) paid by participants and beneficiaries.
            ``(9) Any impact on premiums by rebates, fees, and any 
        other remuneration paid by drug manufacturers to the plan or 
        its administrators or service providers, with respect to 
        prescription drugs prescribed to participants or beneficiaries 
        in the plan, including--
                    ``(A) the amounts so paid for each therapeutic 
                class of drugs; and
                    ``(B) the amounts so paid for each of the 25 drugs 
                that yielded the highest amount of rebates and other 
                remuneration under the plan from drug manufacturers 
                during the plan year.
            ``(10) Any reduction in premiums and out-of-pocket costs 
        associated with rebates, fees, or other remuneration described 
        in paragraph (9).
    ``(b) Report.--Not later than 18 months after the date on which the 
first report is required under subsection (a) and biannually 
thereafter, the Secretary, acting in coordination with the Inspector 
General of the Department of the Treasury, shall make available on the 
internet website of the Department of the Treasury a report on 
prescription drug reimbursements under group health plans, prescription 
drug pricing trends, and the role of prescription drug costs in 
contributing to premium increases or decreases under such plans, 
aggregated in such a way as no drug or plan specific information will 
be made public.
    ``(c) Privacy Protections.--No confidential or trade secret 
information submitted to the Secretary under subsection (a) shall be 
included in the report under subsection (b).''.
    (d) Clerical Amendments.--
            (1) ERISA.--The table of contents in section 1 of the 
        Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 
        et seq.) is amended by inserting after the item relating to 
        section 714 the following new items:

``Sec. 715. Additional market reforms.
``Sec. 716. Reporting on pharmacy benefits and drug costs.''.
            (2) IRC.--The table of sections for subchapter B of chapter 
        100 of the Internal Revenue Code of 1986 is amended by adding 
        at the end the following new item:

``Sec. 9816. Reporting on pharmacy benefits and drug costs.''.
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