H.R. 2450 — Prescription Drug Transparency and Affordability Act

This section establishes oversight and semiannual (or quarterly, if requested by the plan) reporting requirements for entities providing pharmacy benefit management (PBM) services to group health plans and health insurance issuers offering group health insurance coverage, effective for plan years beginning on or after 30 months after enactment. For contracts entered into, extended, or renewed on or after such effective date, plans, issuers, and PBMs may not contract with applicable entities (e.g., drug manufacturers or pharmacies) unless those entities agree not to restrict information disclosure to the plan and to provide data needed for PBM reports. (PBMs administer prescription drug benefits for health plans by negotiating prices, formularies, and rebates with pharmacies and manufacturers.) The required reports, provided in plain language and machine-readable format, must disclose for each covered drug (by National Drug Code): (1) contracted compensation paid to the PBM and to pharmacies; (2) the difference between those amounts; (3) drug names and dispensing channels (retail, mail order, specialty); (4) for each channel, whether brand or generic, with wholesale acquisition cost (for brands) or average wholesale price (for generics) per days supply and dosage unit, plus claims volume, participants affected, dosage units, and days supply; (5) net price per course of treatment or fill after rebates and discounts; (6) participants' out-of-pocket spending (copays, coinsurance, deductibles); (7) total net spending; and (8) rebates, fees, or other remuneration received or expected from applicable entities. These details apply fully to self-insured large employer plans and may be elected for insured large-group coverage.