Title: Creating Transparency to Have Drug Rebates Unlocked (C–THRU) Act of 2019
Policy area: Health

Summary:
Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019
This bill establishes a series of requirements relating to drug rebates and discounts under Medicare and Medicare Advantage (MA).
Specifically, for each pharmacy benefits manager (PBM) that contracts with a prescription drug plan (PDP) under Medicare or MA, or with a qualified health benefits plan offered through a health insurance exchange, HHS must publish on its website (1) the amount and type of rebates and discounts negotiated by the PBM and the extent to which these rebates and discounts are passed on to the plan sponsor, and (2) the difference between the amount paid by the plan sponsor to the PBM and the amount paid by the PBM to pharmacies.
As a condition of participation as a contractor under Medicare or MA, a PBM must pass on to a PDP sponsor a minimum percentage, as established by HHS, of the amount of rebates and discounts negotiated by the PBM that are attributable to patient utilization under the plan.
The bill also modifies requirements regarding Medicare enrollees' access to negotiated drug prices. Current law requires a PDP sponsor to provide enrollees in Medicare or MA with access to negotiated drug prices that account for rebates and discounts. The bill requires that, with respect to a covered drug, a negotiated price (or, if necessary, an approximate negotiated price) be provided at the point of sale.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 476 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 476

  To amend titles XI and XVIII of the Social Security Act to provide 
   greater transparency of discounts provided by drug manufacturers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 13, 2019

    Mr. Wyden (for himself, Mr. Brown, Mr. Carper, and Mr. Tester) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend titles XI and XVIII of the Social Security Act to provide 
   greater transparency of discounts provided by drug manufacturers.

    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 ``Creating Transparency to Have Drug 
Rebates Unlocked (C-THRU) Act of 2019''.

SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS.

    (a) In General.--Section 1150A of the Social Security Act (42 
U.S.C. 1320b-23) is amended--
            (1) in subsection (c), in the matter preceding paragraph 
        (1), by striking ``this section'' and inserting ``subsection 
        (b)(1)''; and
            (2) by adding at the end the following new subsection:
    ``(e) Public Availability of Certain Information.--In order to 
allow patients and employers to compare PBMs' ability to negotiate 
rebates, discounts, and price concessions and the amount of such 
rebates, discounts, and price concessions that are passed through to 
plan sponsors, beginning January 1, 2020, the Secretary shall make 
available on the Internet website of the Department of Health and Human 
Services the information provided to the Secretary under paragraphs (2) 
and (3) of subsection (b) with respect to each PBM. The Secretary shall 
ensure that such information is displayed in a manner that prevents the 
disclosure of information on rebates, discounts, and price concessions 
with respect to an individual drug or an individual plan.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on January 1, 2020.

SEC. 3. MINIMUM DRUG DISCOUNTS REQUIRED TO BE PASSED THROUGH TO THE 
              PLAN SPONSOR.

    (a) In General.--Section 1150A of the Social Security Act (42 
U.S.C. 1320b-23), as amended by section 2(a)(2), is amended--
            (1) in the heading, by inserting ``; minimum drug discounts 
        required to be passed through to the plan sponsor'' before the 
        period at the end; and
            (2) by adding at the end the following new subsection:
    ``(f) Minimum Drug Discounts Required To Be Passed Through to the 
Plan Sponsor.--
            ``(1) Requirement.--Beginning January 1, 2022, a PBM that 
        manages prescription drug coverage under a contract with a PDP 
        sponsor or MA organization described in subsection (b)(1) or a 
        qualified health benefits plan described in subsection (b)(2), 
        shall, with respect to the plan sponsor of a health benefits 
        plan, pass through to the plan sponsor a minimum percent (as 
        established by the Secretary) of the aggregate amount of the 
        rebates, discounts, or price concessions that the PBM 
        negotiates that are attributable to patient utilization under 
        the plan.
            ``(2) Establishment.--The Secretary shall establish the 
        minimum percent described in paragraph (1) in such a manner as 
        will ensure that patients receive the maximum benefit of 
        rebates, discounts, or price concessions while taking into 
        account the costs of negotiating such rebates, discounts, and 
        price concessions.
            ``(3) Enforcement.--A PDP sponsor of a prescription drug 
        plan or an MA organization offering an MA-PD plan under part D 
        of title XVIII may not contract with a PBM that is not in 
        compliance with the requirement under paragraph (1).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on January 1, 2022.

SEC. 4. PART D NEGOTIATED PRICES REQUIRED TO TAKE INTO ACCOUNT ALL 
              PRICE CONCESSIONS AT THE POINT-OF-SALE.

    (a) In General.--Section 1860D-2(d)(1)(B) of the Social Security 
Act (42 U.S.C. 1395w-102(d)(1)(B)) is amended--
            (1) by striking ``prices.--For purposes'' and inserting 
        ``prices.--
                            ``(i) In general.--For purposes''; and
            (2) by adding at the end the following new clause:
                            ``(ii) Negotiated prices at point-of-
                        sale.--
                                    ``(I) In general.--Negotiated 
                                prices for covered part D drugs 
                                described in clause (i), including all 
                                price negotiated concessions, shall be 
                                provided at the point-of-sale of the 
                                covered part D drug. If the negotiated 
                                price, including all negotiated price 
                                concessions, is not possible to 
                                calculate at the point-of-sale, an 
                                approximate negotiated price (as 
                                established by the Secretary) shall be 
                                used under the prescription drug plan 
                                or MA-PD plan.
                                    ``(II) Approximate negotiated 
                                price.--In determining an approximate 
                                negotiated price for a covered part D 
                                drug under subclause (I), the Secretary 
                                shall ensure that--
                                            ``(aa) such price reflects 
                                        the estimated negotiated price 
                                        that is based on the previous 
                                        year's negotiated price 
                                        concessions negotiated under 
                                        the plan for all or similar 
                                        covered part D drugs or is 
                                        based on such other factors as 
                                        the Secretary may determine 
                                        appropriate; and
                                            ``(bb) the use of such 
                                        price does not prevent the use 
                                        of value-based contracts 
                                        between drug manufacturers, PDP 
                                        sponsors, MA organizations, and 
                                        pharmacies.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to plan years beginning on or after January 1, 2021.
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