Public Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act

Bill: 116-hr-2115
Sponsor: full_name: Rep. Spanberger, Abigail Davis [D-VA-7]
Introduced: 2019-04-08
Policy area: Health
Subjects: Business records

Government information and archives

Health care costs and insurance

Inflation and prices

Prescription drugs

Retail and wholesale trades
Latest action: action_date: 2019-10-29
text: Received in the Senate and Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2019-04-08
action_desc: Introduced in House
text: <p><b>Public Disclosure of Drug Discounts Act</b></p> <p>This bill requires the Centers for Medicare &amp; Medicaid Services (CMS) to publish certain payment information regarding pharmacy benefit managers (PBMs) and prescription drugs. Specifically, the CMS must publish certain information, as reported by PBMs, relating to generic dispensing rates, drug discounts and rebates, and payments between PBMs, health plans, and pharmacies, in accordance with specified confidentiality requirements.</p>

action_date: 2019-10-28
action_desc: Passed House
text: <p><b>Public Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act</b></p> <p>This bill requires the Centers for Medicare &amp; Medicaid Services (CMS) to publish certain payment information regarding pharmacy benefit managers (PBMs) and prescription drugs. Specifically, the CMS must publish certain information, as reported by PBMs, relating to generic dispensing rates, drug discounts and rebates, and payments between PBMs, health plans, and pharmacies, in accordance with specified confidentiality requirements.</p> <p>The bill also provides statutory authority for certain provisions of the CMS rule titled &quot;Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,&quot; published on May 23, 2019. The rule requires, in part, Medicare prescription drug plan sponsors to implement an electronic, real-time benefit tool that is capable of integrating with at least one prescriber's electronic prescribing system or electronic health record. The tool must provide prescribers with patient-specific, real-time formulary and benefit information, including information regarding cost-sharing, formulary alternatives, and utilization management requirements. The rule takes effect January 1, 2021. </p>

tv_txt: I 116th CONGRESS 1st Session H. R. 2115 IN THE HOUSE OF REPRESENTATIVES April 8, 2019 Ms. Spanberger (for herself, Mr. Arrington , and Mr. Brendan F. Boyle of Pennsylvania ) 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 XI of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers.

1. Short title This Act may be cited as the Public Disclosure of Drug Discounts Act . 2. Public disclosure of drug discounts 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 inserting (other than as permitted under subsection (e)) after disclosed by the Secretary ; and (2) by adding at the end the following new subsection: (e) Public availability of certain information (1) In general In order to allow the comparison of 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 with respect to the second preceding calendar year provided to the Secretary on generic dispensing rates (as described in paragraph (1) of subsection (b)) and information provided to the Secretary under paragraphs (2) and (3) of such subsection that, as determined by the Secretary, is with respect to each PBM. (2) Availability of data In carrying out paragraph (1), the Secretary shall ensure the following: (A) Confidentiality The information described in such paragraph 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) Class of drug The information described in such paragraph is made available by class of drug, using an existing classification system, but only if the class contains such number of drugs, as specified by the Secretary, to ensure confidentiality of proprietary information or other information that is prevented to be disclosed under subparagraph (A). .

tv_txt: I 116th CONGRESS 1st Session H. R. 2115 IN THE HOUSE OF REPRESENTATIVES AN ACT To amend titles XI and XVIII of the Social Security Act to provide greater transparency for discounts provided by manufacturers, to include real-time benefit information as part of a prescription drug plan’s electronic prescription program under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Public Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act . 2. Public disclosure of drug discounts 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 inserting (other than as permitted under subsection (e)) after disclosed by the Secretary ; and (2) by adding at the end the following new subsection: (e) Public availability of certain information (1) In general In order to allow the comparison of PBMs’ ability to negotiate rebates, discounts, direct and indirect remuneration fees, administrative fees, and price concessions and the amount of such rebates, discounts, direct and indirect remuneration fees, administrative fees, 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 with respect to the second preceding calendar year provided to the Secretary on generic dispensing rates (as described in paragraph (1) of subsection (b)) and information provided to the Secretary under paragraphs (2) and (3) of such subsection that, as determined by the Secretary, is with respect to each PBM. (2) Availability of data In carrying out paragraph (1), the Secretary shall ensure the following: (A) Confidentiality The information described in such paragraph is displayed in a manner that prevents the disclosure of information, with respect to an individual drug or an individual plan, on rebates, discounts, direct and indirect remuneration fees, administrative fees, and price concessions. (B) Class of drug The information described in such paragraph is made available by class of drug, using an existing classification system, but only if the class contains such number of drugs, as specified by the Secretary (but not fewer than three drugs), to ensure confidentiality of proprietary information or other information that is prevented to be disclosed under subparagraph (A). . 3. Requiring prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription program under the Medicare program Section 1860D–4(e)(2) of the Social Security Act ( 42 U.S.C. 1395w–104(e)(2) ) is amended— (1) in subparagraph (D), by striking To the extent and inserting Except as provided in subparagraph (F), to the extent ; and (2) by adding at the end the following new subparagraph: (F) Real-time benefit information (i) In general Not later than January 1, 2021, the program shall implement real-time benefit tools that are capable of integrating with a prescribing health care professional’s electronic prescribing or electronic health record system for the transmission of formulary and benefit information in real time to prescribing health care professionals. With respect to a covered part D drug, such tools shall be capable of transmitting such information specific to an individual enrolled in a prescription drug plan. Such information shall include the following: (I) A list of any clinically-appropriate alternatives to such drug included in the formulary of such plan. (II) Cost-sharing information for such drug and such alternatives, including a description of any variance in cost sharing based on the pharmacy dispensing such drug or such alternatives. (III) Information relating to whether such drug is included in the formulary of such plan and any prior authorization or other utilization management requirements applicable to such drug and such alternatives so included. (ii) Electronic transmission The provisions of subclauses (I) and (II) of clause (ii) of subparagraph (E) shall apply to an electronic transmission described in clause (i) in the same manner as such provisions apply with respect to an electronic transmission described in clause (i) of such subparagraph. (iii) Special rule for 2021 The program shall be deemed to be in compliance with clause (i) for 2021 if the program complies with the provisions of section 423.160(b)(7) of title 42, Code of Federal Regulations (or a successor regulation), for such year. (iv) Rule of construction Nothing in this subparagraph shall be construed as to allow a real-time benefits tool to steer an individual, without the consent of the individual, to a particular pharmacy or pharmacy setting over their preferred pharmacy setting nor prohibit the designation of a preferred pharmacy under such tool. . 4. Sense of Congress regarding the need to expand commercially available drug pricing comparison platforms It is the sense of Congress that— (1) commercially available drug pricing comparison platforms can, at no cost, help patients find the lowest price for their medications at their local pharmacy; (2) such platforms should be integrated, to the maximum extent possible, in the health care delivery ecosystem; and (3) pharmacy benefit managers should work to disclose generic and brand name drug prices to such platforms to ensure that— (A) patients can benefit from the lowest possible price available to them; and (B) overall drug prices can be reduced as more educated purchasing decisions are made based on price transparency.

Passed the House of Representatives October 28, 2019. Cheryl L. Johnson, Clerk.

tv_txt: IIB 116th CONGRESS 1st Session H. R. 2115 IN THE SENATE OF THE UNITED STATES October 29, 2019 Received; read twice and referred to the Committee on Finance AN ACT To amend titles XI and XVIII of the Social Security Act to provide greater transparency for discounts provided by manufacturers, to include real-time benefit information as part of a prescription drug plan’s electronic prescription program under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Public Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act . 2. Public disclosure of drug discounts 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 inserting (other than as permitted under subsection (e)) after disclosed by the Secretary ; and (2) by adding at the end the following new subsection: (e) Public availability of certain information (1) In general In order to allow the comparison of PBMs’ ability to negotiate rebates, discounts, direct and indirect remuneration fees, administrative fees, and price concessions and the amount of such rebates, discounts, direct and indirect remuneration fees, administrative fees, 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 with respect to the second preceding calendar year provided to the Secretary on generic dispensing rates (as described in paragraph (1) of subsection (b)) and information provided to the Secretary under paragraphs (2) and (3) of such subsection that, as determined by the Secretary, is with respect to each PBM. (2) Availability of data In carrying out paragraph (1), the Secretary shall ensure the following: (A) Confidentiality The information described in such paragraph is displayed in a manner that prevents the disclosure of information, with respect to an individual drug or an individual plan, on rebates, discounts, direct and indirect remuneration fees, administrative fees, and price concessions. (B) Class of drug The information described in such paragraph is made available by class of drug, using an existing classification system, but only if the class contains such number of drugs, as specified by the Secretary (but not fewer than three drugs), to ensure confidentiality of proprietary information or other information that is prevented to be disclosed under subparagraph (A). . 3. Requiring prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription program under the Medicare program Section 1860D–4(e)(2) of the Social Security Act ( 42 U.S.C. 1395w–104(e)(2) ) is amended— (1) in subparagraph (D), by striking To the extent and inserting Except as provided in subparagraph (F), to the extent ; and (2) by adding at the end the following new subparagraph: (F) Real-time benefit information (i) In general Not later than January 1, 2021, the program shall implement real-time benefit tools that are capable of integrating with a prescribing health care professional’s electronic prescribing or electronic health record system for the transmission of formulary and benefit information in real time to prescribing health care professionals. With respect to a covered part D drug, such tools shall be capable of transmitting such information specific to an individual enrolled in a prescription drug plan. Such information shall include the following: (I) A list of any clinically-appropriate alternatives to such drug included in the formulary of such plan. (II) Cost-sharing information for such drug and such alternatives, including a description of any variance in cost sharing based on the pharmacy dispensing such drug or such alternatives. (III) Information relating to whether such drug is included in the formulary of such plan and any prior authorization or other utilization management requirements applicable to such drug and such alternatives so included. (ii) Electronic transmission The provisions of subclauses (I) and (II) of clause (ii) of subparagraph (E) shall apply to an electronic transmission described in clause (i) in the same manner as such provisions apply with respect to an electronic transmission described in clause (i) of such subparagraph. (iii) Special rule for 2021 The program shall be deemed to be in compliance with clause (i) for 2021 if the program complies with the provisions of section 423.160(b)(7) of title 42, Code of Federal Regulations (or a successor regulation), for such year. (iv) Rule of construction Nothing in this subparagraph shall be construed as to allow a real-time benefits tool to steer an individual, without the consent of the individual, to a particular pharmacy or pharmacy setting over their preferred pharmacy setting nor prohibit the designation of a preferred pharmacy under such tool. . 4. Sense of Congress regarding the need to expand commercially available drug pricing comparison platforms It is the sense of Congress that— (1) commercially available drug pricing comparison platforms can, at no cost, help patients find the lowest price for their medications at their local pharmacy; (2) such platforms should be integrated, to the maximum extent possible, in the health care delivery ecosystem; and (3) pharmacy benefit managers should work to disclose generic and brand name drug prices to such platforms to ensure that— (A) patients can benefit from the lowest possible price available to them; and (B) overall drug prices can be reduced as more educated purchasing decisions are made based on price transparency.

Passed the House of Representatives October 28, 2019. Cheryl L. Johnson, Clerk.