Prescription Drug Price Transparency Act
This bill adds certain transparency requirements for pharmacy benefits managers under Medicare, Medicare Advantage, TRICARE, and the Federal Employees Health Benefits Program.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1316 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 1316
To amend title XVIII of the Social Security Act to provide for pharmacy
benefits manager standards under the Medicare prescription drug program
and Medicare Advantage program to further transparency of payment
methodologies to pharmacies, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 2, 2017
Mr. Collins of Georgia (for himself, Mr. Loebsack, Mr. Carter of
Georgia, Mr. Duncan of Tennessee, Mrs. McMorris Rodgers, Mr. Blum, Mr.
Sarbanes, and Mr. Babin) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means, Armed Services, and Oversight and
Government Reform, 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 XVIII of the Social Security Act to provide for pharmacy
benefits manager standards under the Medicare prescription drug program
and Medicare Advantage program to further transparency of payment
methodologies to pharmacies, 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. SHORT TITLE.
This Act may be cited as the ``Prescription Drug Price Transparency
Act''.
SEC. 2. PHARMACY BENEFITS MANAGER STANDARDS UNDER THE MEDICARE PROGRAM
FOR PRESCRIPTION DRUG PLANS AND MA-PD PLANS.
(a) In General.--Section 1860D-12(b) of the Social Security Act (42
U.S.C. 1395w-112(b)) is amended by adding at the end the following new
paragraph:
``(7) Pharmacy benefits manager transparency
requirements.--Each contract entered into with a PDP sponsor
under this part with respect to a prescription drug plan
offered by such sponsor or with an MA organization offering an
MA-PD plan under part C shall provide that the sponsor or
organization, respectively, may not enter into a contract with
any pharmacy benefits manager (referred to in this paragraph as
a `PBM') to manage the prescription drug coverage provided
under such plan, or to control the costs of the prescription
drug coverage under such plan, unless the PBM adheres to the
following criteria when handling personally identifiable
utilization and claims data or other sensitive patient data:
``(A) The PBM may not transmit any personally
identifiable utilization, protected health information,
or claims data, with respect to a plan enrollee, to a
pharmacy owned by a PBM if the plan enrollee has not
voluntarily elected in writing or via secure electronic
means to fill that particular prescription at the PBM-
owned pharmacy.
``(B) The PBM may not require that a plan enrollee
use a retail pharmacy, mail order pharmacy, specialty
pharmacy, or other pharmacy entity providing pharmacy
services in which the PBM has an ownership interest or
that has an ownership interest in the PBM, or provide
an incentive to a plan enrollee to encourage the
enrollee to use a retail pharmacy, mail order pharmacy,
specialty pharmacy, or other pharmacy entity providing
pharmacy services in which the PBM has an ownership
interest or that has an ownership interest in the PBM,
if the incentive is applicable only to such
pharmacies.''.
(b) Regular Update of Prescription Drug Pricing Standard.--
Paragraph (6) of section 1860D-12(b) of the Social Security Act (42
U.S.C. 1395w-112(b)) is amended to read as follows:
``(6) Regular update of prescription drug pricing
standard.--
``(A) In general.--If the PDP sponsor of a
prescription drug plan (or MA organization offering an
MA-PD plan) uses a standard for reimbursement (as
described in subparagraph (B)) of pharmacies based on
the cost of a drug, each contract entered into with
such sponsor under this part (or organization under
part C) with respect to the plan shall provide that the
sponsor (or organization) shall--
``(i) update such standard not less
frequently than once every 7 days, beginning
with an initial update on January 1 of each
year, to accurately reflect the market price of
acquiring the drug;
``(ii) disclose to applicable pharmacies
and the contracting entities of such pharmacies
the sources used for making any such update
immediately without requirement of request;
``(iii) if the source for such a standard
for reimbursement is not publicly available,
disclose to the applicable pharmacies and the
respective contracting entities of such
pharmacies all individual drug prices to be so
updated in advance of the use of such prices
for the reimbursement of claims;
``(iv) establish a process to appeal,
investigate, and resolve disputes regarding
individual drug prices that are less than the
pharmacy acquisition price for such drug, which
must be adjudicated within 7 days of the
pharmacy filing its appeal; and
``(v) provide all such pricing data in an
.xml spreadsheet format or a comparable easily
accessible and complete spreadsheet format.
``(B) Prescription drug pricing standard defined.--
For purposes of subparagraph (A), a standard for
reimbursement of a pharmacy is any methodology or
formula for varying the pricing of a drug or drugs
during the term of the pharmacy reimbursement contract
that is based on the cost of the drug involved,
including drug pricing references and amounts that are
based upon average wholesale price, wholesale average
cost, average manufacturer price, average sales price,
maximum allowable cost (MAC), or other costs, whether
publicly available or not.''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2018.
SEC. 3. REGULAR UPDATE OF PRESCRIPTION DRUG PRICING STANDARD UNDER
TRICARE RETAIL PHARMACY PROGRAM.
Section 1074g(d) of title 10, United States Code, is amended by
adding at the end the following new paragraph:
``(3) To the extent practicable, with respect to the TRICARE retail
pharmacy program described in subsection (a)(2)(E)(ii), the Secretary
shall ensure that a contract entered into with a TRICARE managed care
support contractor includes requirements described in section 1860D-
12(b)(6) of the Social Security Act (42 U.S.C. 1395w-112(b)(6)) to
ensure the provision of information regarding the pricing standard for
prescription drugs.''.
SEC. 4. PRESCRIPTION DRUG TRANSPARENCY IN THE FEDERAL EMPLOYEES HEALTH
BENEFITS PROGRAM.
(a) In General.--Section 8902 of title 5, United States Code, is
amended by adding at the end the following new subsections:
``(p) A contract may not be made or a plan approved under this
chapter under which a carrier has an agreement with a pharmacy benefits
manager (in this subsection referred to as a `PBM') to manage
prescription drug coverage or to control the costs of the prescription
drug coverage unless the carrier and PBM adhere to the following
criteria:
``(1) The PBM may not transmit any personally identifiable
utilization, protected health information, or claims data with
respect to an individual enrolled under such contract or plan
to a pharmacy owned by the PBM if the individual has not
voluntarily elected in writing or via secure electronic means
to fill that particular prescription at such a pharmacy.
``(2) The PBM may not require that an individual enrolled
under such contract or plan use a retail pharmacy, mail order
pharmacy, specialty pharmacy, or other pharmacy entity
providing pharmacy services in which the PBM has an ownership
interest or that has an ownership interest in the PBM or
provide an incentive to a plan enrollee to encourage the
enrollee to use a retail pharmacy, mail order pharmacy,
specialty pharmacy, or other pharmacy entity providing pharmacy
services in which the PBM has an ownership interest or that has
an ownership interest in the PBM, if the incentive is
applicable only to such pharmacies.
``(q)(1) If a contract made or plan approved under this chapter
provides for a standard for reimbursement (as described in paragraph
(2)) with respect to a prescription drug plan, such contract or plan
shall provide that the applicable carrier--
``(A) update such standard not less frequently than once
every 7 days, beginning with an initial update on January 1 of
each year, to accurately reflect the market price of acquiring
the drug;
``(B) disclose to applicable pharmacies and the contracting
entities of such pharmacies the sources used for making any
such update immediately without requirement of request;
``(C) if the source for such a standard for reimbursement
is not publicly available, disclose to the applicable
pharmacies and contracting entities of such pharmacies all
individual drug prices to be so updated in advance of the use
of such prices for the reimbursement of claims;
``(D) establish a process to appeal, investigate, and
resolve disputes regarding individual drug prices that are less
than the pharmacy acquisition price for such drug, which must
be adjudicated within 7 days of the pharmacy filing its appeal;
and
``(E) provide all such pricing data in an .xml spreadsheet
format or a comparable easily accessible and complete
spreadsheet format.
``(2) For purposes of paragraph (1), a standard for reimbursement
of a pharmacy is any methodology or formula for varying the pricing of
a drug or drugs during the term of the pharmacy reimbursement contract
that is based on the cost of the drug involved, including drug pricing
references and amounts that are based upon average wholesale price,
wholesale average cost, average manufacturer price, average sales
price, maximum allowable cost, or other costs, whether publicly
available or not.''.
(b) Application.--The amendment made by subsection (a) shall apply
to any contract entered into under section 8902 of title 5, United
States Code, on or after the date of enactment of this section.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, and Oversight and Government Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, and Oversight and Government Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, and Oversight and Government Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, and Oversight and Government Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Armed Services, and Oversight and Government Reform, 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.
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Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Military Personnel.