Know the Lowest Price Act of 2018

Bill: 115-s-2553
Sponsor: full_name: Sen. Stabenow, Debbie [D-MI]
Introduced: 2018-03-14
Policy area: Health
Subjects: Health care costs and insurance

Health care coverage and access

Insurance industry and regulation

Medicare

Prescription drugs
Latest action: action_date: 2018-10-10
text: Became Public Law No: 115-262.

Summaries:
action_date: 2018-03-14
action_desc: Introduced in Senate
text: <p><b>Know the Lowest Price Act of 2018</b></p> <p>This bill prohibits a health-benefits plan or pharmacy-benefits manager under Medicare or Medicare Advantage&nbsp;from restricting a pharmacy from informing an enrollee of any difference between the price of a drug under the plan and the price of the drug without health-insurance coverage.</p>

action_date: 2018-09-04
action_desc: Passed Senate amended
text: <p><b>Know the Lowest Price Act of 2018</b></p> <p>(Sec. 2) This bill prohibits a prescription drug plan under Medicare or Medicare Advantage&nbsp;from restricting a pharmacy from informing an enrollee of any difference between the price, copayment, or coinsurance of a drug under the plan and a lower price of the drug without health-insurance coverage. (Such restrictions are commonly referred to as gag clauses.)</p>

action_date: 2018-09-25
action_desc: Passed House without amendment
text: <p><b>Know the Lowest Price Act of 2018</b></p> <p>(Sec. 2) This bill prohibits a prescription drug plan under Medicare or Medicare Advantage&nbsp;from restricting a pharmacy from informing an enrollee of any difference between the price, copayment, or coinsurance of a drug under the plan and a lower price of the drug without health-insurance coverage. (Such restrictions are commonly referred to as gag clauses.)</p>

action_date: 2018-10-10
action_desc: Public Law
text: <p><b>Know the Lowest Price Act of 2018</b></p> <p>(Sec. 2) This bill prohibits a prescription drug plan under Medicare or Medicare Advantage&nbsp;from restricting a pharmacy from informing an enrollee of any difference between the price, copayment, or coinsurance of a drug under the plan and a lower price of the drug without health-insurance coverage. (Such restrictions are commonly referred to as gag clauses.)</p>

tv_txt: II 115th CONGRESS 2d Session S. 2553 IN THE SENATE OF THE UNITED STATES March 14, 2018 Ms. Stabenow (for herself, Ms. Collins , Mr. Wyden , Mr. Cassidy , Mrs. McCaskill , and Mr. Barrasso ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to prohibit health plans and pharmacy benefit managers from restricting pharmacies from informing individuals regarding the prices for certain drugs and biologicals.

1. Short title This Act may be cited as the Know the Lowest Price Act of 2018 . 2. Prohibition on limiting certain information on drug prices (a) In general 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— (1) any health benefits plan offered by the sponsor or organization, including a prescription drug plan and an MA–PD plan, does not restrict a pharmacy that dispenses a prescription drug or biological from informing (or penalize such pharmacy for informing) an enrollee of any differential between the price of the drug or biological to the enrollee under the plan and the price the individual would pay for the drug or biological if the enrollee obtained the drug without using any health insurance coverage; and (2) any entity that provides pharmacy benefits management services under a contract with any health benefits plan offered by the sponsor or organization does not, with respect to such plan or any health benefits plan that the entity contracts with to provide pharmacy benefits management services and that is offered by an entity other than such sponsor or organization, restrict a pharmacy that dispenses a prescription drug or biological from informing (or penalize such pharmacy for informing) an enrollee of any differential between the price of the drug or biological to the enrollee under the plan and the price the individual would pay for the drug or biological if the enrollee obtained the drug without using any health insurance coverage. . (b) Effective date The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2020.

tv_txt: 115th CONGRESS 2d Session S. 2553 IN THE SENATE OF THE UNITED STATES AN ACT To amend title XVIII of the Social Security Act to prohibit health plans and pharmacy benefit managers from restricting pharmacies from informing individuals regarding the prices for certain drugs and biologicals.

1. Short title This Act may be cited as the Know the Lowest Price Act of 2018 . 2. Prohibition on limiting certain information on drug prices (a) In general 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. . (b) Effective date The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2020.

Passed the Senate September 4, 2018. Secretary

tv_txt: IC 115th CONGRESS 2d Session S. 2553 IN THE HOUSE OF REPRESENTATIVES September 5, 2018 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 AN ACT To amend title XVIII of the Social Security Act to prohibit health plans and pharmacy benefit managers from restricting pharmacies from informing individuals regarding the prices for certain drugs and biologicals.

1. Short title This Act may be cited as the Know the Lowest Price Act of 2018 . 2. Prohibition on limiting certain information on drug prices (a) In general 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. . (b) Effective date The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2020.

Passed the Senate September 4, 2018. Julie E. Adams, Secretary

tv_txt: One Hundred Fifteenth Congress of the United States of America 2d Session Begun and held at the City of Washington on Wednesday, the third day of January, two thousand and eighteen S. 2553 IN THE SENATE OF THE UNITED STATES AN ACT To amend title XVIII of the Social Security Act to prohibit Medicare part D plans from restricting pharmacies from informing individuals regarding the prices for certain drugs and biologicals.

1. Short title This Act may be cited as the Know the Lowest Price Act of 2018 . 2. Prohibition on limiting certain information on drug prices (a) In general 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. . (b) Effective date The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2020.

Speaker of the House of Representatives Vice President of the United States and President of the Senate