,,ii #aahth ,,congress #ast ,session ,s4 #acci ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #bg1 #bjbc,mr4 ,sanders 7for himself1 ,mr4 ,cassidy1 ,mrs4 ,murray1 and ,mr4 ,marshall7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to provide for increased oversight of entities that provide pharmacy benefit management services on behalf of group health plans and health insurance coverage4 #a4 ,short title ,this ,act may be cited as the ,pharmacy ,benefit ,manager ,reform ,act4 #b4 ,oversight of entities that provide pharmacy benefit management services 7a7 ,,phsa ,title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended-- 7#a7 in part ,d 7#db ,u4,s4,c4 #cjj;gg-#aaa et seq471 by adding at the end the following new section3 #bgii;,a-#aa4 ,oversight of entities that provide pharmacy benefit management services 7a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a group health plan or health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of such a plan or issuer shall not enter into a contract with an applicable entity that limits the disclosure of information to plan sponsors in such a manner that prevents the plan or issuer1 or an entity providing pharmacy benefit management services on behalf of a plan or issuer1 from making the reports described in subsection 7b74 7b7 ,reports 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 not less frequently than annually1 an entity providing pharmacy benefit management services on behalf of a covered group health plan shall submit to the plan sponsor of such covered group health plan a report in accordance with this subsection and make such report available to the plan sponsor in a machine-readable format and1 as the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury may determine1 other formats4 ,each such report shall include1 with respect to the covered group health plan-- 7,a7 as applicable1 information collected from drug manufacturers by such issuer or entity on the total amount of copayment assistance dollars paid1 or copayment cards applied1 that were funded by the drug manufacturer with respect to the participants and beneficiaries in such plan2 7,b7 a list of each drug covered by such plan or entity providing pharmacy benefit management services that was billed during the reporting period1 including1 with respect to each such drug during the reporting period-- 7i7 the brand name1 generic or nonproprietary name1 and ,national ,drug ,code2 7ii7 the number of participants and beneficiaries for whom the drug was billed during the reporting period1 the total number of prescription claims for the drug 7including original prescriptions and refills71 and the total number of dosage units of the drug dispensed across the reporting period2 7iii7 for each claim or dosage unit described in clause 7ii71 the type of dispensing channel used1 such as retail1 mail order1 or specialty pharmacy2 7iv7 the wholesale acquisition cost1 listed as cost per days supply1 cost per dosage unit1 and cost per typical course of treatment 7as applicable72 7v7 the total out-of-pocket spending by participants and beneficiaries on such drug after application of any benefits under the plan or coverage1 including participant and beneficiary spending through copayments1 coinsurance1 and deductibles1 but not including any amounts spent by participants and beneficiaries on drugs not covered under the plan or coverage or for which no claim is submitted to the plan or coverage2 and 7vi7 for any drug for which gross spending by the plan exceeded #aj1jjj and that is one of the #ej prescription drugs for which the group health plan spent the most on prescription drug benefits during the reporting period-- 7,i7 a list of all other drugs in the same therapeutic class1 including brand name drugs and biological products and generic drugs or biosimilar biological products that are in the same therapeutic class as such drug2 and 7,,ii7 if applicable1 the rationale for preferred formulary placement of such drug in that therapeutic class1 selected from a list of standard rationales established by the ,secretary2 7,c7 a list of each therapeutic class of drugs that were dispensed under the health plan during the reporting period1 and1 with respect to each such therapeutic class of drugs1 during the reporting period-- 7i7 total gross spending by the plan1 before rebates1 fees1 alternative discounts1 or other remuneration2 7ii7 the number of participants and beneficiaries who filled a prescription for a drug in that class2 7iii7 if applicable to that class1 a description of the formulary tiers and utilization management mechanisms 7such as prior authorization or step therapy7 employed for drugs in that class2 7iv7 the total out-of-pocket spending by participants and beneficiaries1 including participant and beneficiary spending through copayments1 coinsurance1 and deductibles2 and 7v7 for each therapeutic class under which #c or more drugs are included on the formulary of such plan-- 7,i7 the amount received1 or expected to be received1 by such entity1 from an applicable entity1 in rebates1 fees1 alternative discounts1 or other remuneration that-- 7aa7 has been paid1 or will be paid1 by such an applicable entity for claims incurred during the reporting period2 or 7bb7 is related to utilization of drugs or drug spending2 7,,ii7 the total net spending by the health plan on that class of drugs2 and 7,,iii7 the net price per typical course of treatment or #cj-;day supply incurred by the health plan and its participants and beneficiaries1 after rebates1 fees1 alternative discounts1 or other remuneration provided by an applicable entity1 for drugs dispensed within such therapeutic class during the reporting period2 7,d7 total gross spending on prescription drugs by the plan during the reporting period1 before rebates1 fees1 alternative discounts1 or other remuneration provided by an applicable entity2 7,e7 the total amount received1 or expected to be received1 by the health plan1 from an applicable entity1 in rebates1 fees1 alternative discounts1 and other remuneration received from any such entities1 related to utilization of drug or drug spending under that health plan during the reporting period2 7,f7 the total net spending on prescription drugs by the health plan during the reporting period2 7,g7 amounts paid directly or indirectly in rebates1 fees1 or any other type of compensation 7as defined in section #djh7;b77#b77;,b77ii77dd77,,aa7 of the ,employee ,retirement ,income ,security ,act of #aigd7 to brokers1 consultants1 advisors1 or any other individual or firm who referred the group health plan's business to the pharmacy benefit manager2 and 7,h7 a summary document that includes such information described in subparagraphs 7,a7 through 7,g7 as the ,secretary determines useful for plan sponsors for purposes of selecting pharmacy benefit management services1 such as an estimated net price to plan sponsor and participant or beneficiary1 a cost per claim1 the fee structure or reimbursement model1 and estimated cost per participant or beneficiary4 7#b7 ,supplementary reporting for intra-company prescription drug transactions 7,a7 ,in general ,a health insurance issuer offering covered group health insurance coverage or an entity providing pharmacy benefit management services under a covered group health plan or covered group health insurance coverage shall submit1 together with the report under paragraph 7#a71 a supplementary report every #f months to the plan sponsor that includes-- 7i7 an explanation of any benefit design parameters that encourage or require participants and beneficiaries in the plan or coverage to fill prescriptions at mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by that issuer or entity providing pharmacy benefit management services under such plan or coverage1 including mandatory mail and specialty home delivery programs1 retail and mail auto-refill programs1 and copayment incentives funded by an entity providing pharmacy benefit management services2 7ii7 the percentage of total prescriptions charged to the plan1 coverage1 or participants and beneficiaries in the plan or coverage1 that were dispensed by mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by the issuer or entity providing pharmacy benefit management services2 and 7iii7 a list of all drugs dispensed by such wholly or partially-owned pharmacy and charged to the plan or coverage1 or participants and beneficiaries of the plan or coverage1 during the applicable quarter1 and1 with respect to each drug-- 7,i7 the amounts charged1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 with respect to participants and beneficiaries in the plan or coverage1 including amounts charged to the plan or coverage and amounts charged to the participants and beneficiaries2 7,,ii7 the median amount charged to the plan or coverage1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 including amounts paid by the participants and beneficiaries1 when the same drug is dispensed by other pharmacies that are not wholly or partially-owned by the issuer or entity and that are included in the pharmacy network of that plan or coverage2 7,,iii7 the interquartile range of the costs1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 including amounts paid by the participants and beneficiaries1 when the same drug is dispensed by other pharmacies that are not wholly or partially-owned by the issuer or entity and that are included in the pharmacy network of that plan or coverage2 7,,iv7 the lowest cost1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 for such drug1 including amounts charged to the plan or issuer and participants and beneficiaries1 that is available from any pharmacy included in the network of the plan or coverage2 7,v7 the net acquisition cost per dosage unit and for a #cj day-supply1 and the acquisition cost per typical course of treatment1 if the drug is subject to a maximum price discount2 and 7,,vi7 other information with respect to the cost of the drug1 as determined by the ,secretary1 such as average sales price1 wholesale acquisition cost1 and national average drug acquisition cost per dosage unit1 per typical course of treatment1 or per #cj-;day supply1 for such drug1 including amounts charged to the plan or issuer and participants and beneficiaries among all pharmacies included in the network of the plan or coverage4 7,b7 ,plans and coverage offered by small employers ,a health insurance issuer offering covered group health insurance coverage that is not covered group health insurance coverage or an entity providing pharmacy benefit management services under a group health plan that is not a covered group health plan or under group health insurance coverage that is not covered group health insurance coverage that conducts transactions with a wholly or partially-owned pharmacy shall submit1 together with the report under paragraph 7#a71 a supplementary report every #f months to the plan sponsor that includes the information described in clauses 7i7 and 7ii7 of subparagraph 7,a74 7#c7 ,privacy requirements 7,a7 ,relationship to ,,hipaa regulations ,nothing in this section shall be construed to modify the requirements for the creation1 receipt1 maintenance1 or transmission of protected health information under the privacy1 security1 breach notification1 and enforcement regulations in parts #afj and #afd of title #de1 ,code of ,federal ,regulations 7or successor regulations74 7,b7 ,requirement ,a report submitted under paragraph 7#a7 or 7#b7 shall contain only summary health information1 as defined in section #afd4ejd7;a7 of title #de1 ,code of ,federal ,regulations 7or successor regulations74 7,c7 ,clarification regarding certain disclosures of information 7i7 ,reasonable restrictions ,nothing in this section prevents a health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of a group health plan or group health insurance coverage from placing reasonable restrictions on the public disclosure of the information contained in a report under paragraph 7#a7 or 7#b74 7ii7 ,limitations ,a health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of a group health plan or group health insurance coverage may not restrict disclosure of such reports to the ,department of ,health and ,human ,services1 the ,department of ,labor1 the ,department of the ,treasury1 or any other ,federal agency responsible for enforcement activities under this section for purposes of enforcement under this section or other applicable law1 or to the ,comptroller ,general of the ,united ,states in accordance with paragraph 7#f74 7#d7 ,use and disclosure by plan sponsors 7,a7 ,prohibition ,a plan sponsor may not-- 7i7 fail or refuse to hire1 or discharge1 any employee1 or otherwise discriminate against any employee with respect to the compensation1 terms1 conditions1 or privileges of employment of the employee1 because of information submitted under paragraph 7#a7 or 7#b7 attributed to the employee or a dependent of the employee2 or 7ii7 limit1 segregate1 or classify the employees of the employer in any way that would deprive or tend to deprive any employee of employment opportunities or otherwise adversely affect the status of the employee as an employee1 because of information submitted under paragraph 7#a7 or 7#b7 attributed to the employee or a dependent of the employee4 7,b7 ,disclosure and redisclosure ,a plan sponsor shall not disclose the information received under paragraph 7#a7 or 7#b7 except-- 7i7 to an occupational or other health researcher if the research is conducted in compliance with the regulations and protections provided for under part #df of title #de1 ,code of ,federal ,regulations 7or successor regulations72 7ii7 in response to an order of a court1 except that the plan sponsor may disclose only the information expressly authorized by such order2 7iii7 to the ,department of ,health and ,human ,services1 the ,department of ,labor1 the ,department of the ,treasury1 or other ,federal agency responsible for enforcement activities under this section2 or 7iv7 to a contractor or agent for purposes of health plan administration1 if such contractor or agent agrees1 in writing1 to abide by the same use and disclosure restrictions as the plan sponsor4 7,c7 ,relationship to ,,hipaa regulations ,with respect to the regulations promulgated by the ,secretary of ,health and ,human ,services under part ,c of title ,,xi of the ,social ,security ,act and section #bfd of the ,health ,insurance ,portability and ,accountability ,act of #aiif1 subparagraph 7,b7 does not prohibit a covered entity 7as defined for purposes of such regulations7 from any use or disclosure of health information that is authorized for the covered entity under such regulations4 ,the previous sentence does not affect the authority of such ,secretary to modify such regulations4 7,d7 ,enforcement 7i7 ,in general ,the powers1 procedures1 and remedies provided in section #bjg of the ,genetic ,information ,nondiscrimination ,act to a person alleging a violation of title ,,ii of such ,act shall be the powers1 procedures1 and remedies this subparagraph provides for any person alleging a violation of this paragraph4 7ii7 ,prohibition against retaliation ,no person shall discriminate against any individual because such individual has opposed any act or practice made unlawful by this paragraph or because such individual made a charge1 testified1 assisted1 or participated in any manner in an investigation1 proceeding1 or hearing under this paragraph4 ,the remedies and procedures otherwise provided for under this subparagraph shall be available to aggrieved individuals with respect to violations of this clause4 7#e7 ,additional reporting 7,a7 ,reporting with respect to group health plans offered by small employers ,for plan years beginning on or after ,january #a1 #bjbe1 not less frequently than annually1 an entity providing pharmacy benefit management services on behalf of a group health plan that is not a covered group health plan shall submit to the plan sponsor of such group health plan a report in accordance with this paragraph1 and make such report available to the plan sponsor in a machine-readable format1 and such other formats as the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury may determine4 ,each such report shall include1 with respect to the applicable group health plan1 the information described in subparagraphs 7,a71 7,d71 7,e71 7,f71 7,g71 and 7,h7 of paragraph 7#a74 7,b7 ,opt-in for group health insurance coverage 7i7 ,in general ,a plan sponsor may1 on an annual basis1 beginning with plan years beginning on or after ,january #a1 #bjbe1 elect to require a health insurance issuer offering group health insurance coverage to submit to such plan sponsor a report in accordance with this subsection4 7ii7 ,contents of reports 7,i7 ,covered group health insurance coverage ,in the case of an issuer that offers covered group health insurance coverage1 a report provided pursuant to clause 7i7 shall include1 with respect to the applicable covered group health insurance coverage1 the information required under paragraph 7#a7 for covered group health plans4 7,,ii7 ,other group health insurance coverage ,in the case of an issuer that offers group health insurance coverage that is not covered group health insurance1 a report provided pursuant to clause 7i7 shall include1 with respect to the applicable group health insurance coverage1 the information described in subparagraphs 7,a71 7,d71 7,e71 7,f71 and 7,g7 of paragraph 7#a74 7iii7 ,application ,for purposes of reports submitted in accordance with this subparagraph1 paragraph 7#a7 shall be applied by substituting group health insurance coverage or health insurance issuer1 as applicable1 for group health plan1 group plan1 and plan where such terms appear in such paragraph4 7iv7 ,required reporting for all group health insurance coverage ,each health insurance issuer of health insurance coverage shall annually submit the information described in paragraph 7#a77;,h71 regardless of whether the plan sponsor made the election described in clause 7i7 for the applicable year4 7#f7 ,submissions to ,,gao ,a health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of a group health plan shall submit to the ,comptroller ,general of the ,united ,states each of the first #b reports submitted to a plan sponsor under paragraph 7#a7 or 7#e7 with respect to such coverage or plan1 and other such reports as requested1 in accordance with the privacy requirements under paragraph 7#c71 and such other information that the ,comptroller ,general determines necessary to carry out the study under section #b7;f7 of the ,pharmacy ,benefit ,manager ,reform ,act4 7#g7 ,standard formats 7,a7 ,in general ,not later than ,june #a1 #bjbd1 the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury shall specify1 through rulemaking1 standard formats for health insurance issuers and entities providing pharmacy benefit management services to submit reports required under this subsection4 7,b7 ,limited form of report ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury shall define through rulemaking a limited form of the reports under paragraphs 7#a7 and 7#b7 required to be submitted to plan sponsors who also are drug manufacturers1 drug wholesalers1 entities providing pharmacy benefit management services1 or other direct participants in the drug supply chain1 in order to prevent anti-competitive behavior4 7c7 ,limitations on spread pricing 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a group health plan or health insurance issuer offering group or individual health insurance coverage shall not charge participants and beneficiaries1 and an entity providing pharmacy benefit management services under such a plan or coverage shall not charge the plan1 issuer1 or participants and beneficiaries1 a price for a prescription drug that exceeds the price paid to the pharmacy for such drug1 excluding penalties paid by the pharmacy 7as described in paragraph 7#b77 to such plan1 issuer1 or entity4 7#b7 ,rule of construction ,for purposes of paragraph 7#a71 penalties paid by pharmacies include only the following3 7,a7 ,a penalty paid if an original claim for a prescription drug was submitted fraudulently by the pharmacy to the plan1 issuer1 or entity4 7,b7 ,a penalty paid if the original claim payment made by the plan1 issuer1 or entity to the pharmacy was inconsistent with the reimbursement terms in any contract between the pharmacy and the plan1 issuer1 or entity4 7,c7 ,a penalty paid if the pharmacist services billed to the plan1 issuer1 or entity were not rendered by the pharmacy4 7d7 ,full rebate pass-,through to plan 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a third-party administrator of a group health plan1 a health insurance issuer offering group health insurance coverage1 or an entity providing pharmacy benefit management services under such health plan or health insurance coverage shall-- 7,a7 remit #ajj percent of rebates1 fees1 alternative discounts1 and other remuneration received from any applicable entity that are related to utilization of drugs under such health plan or health insurance coverage1 to the group health plan2 and 7,b7 ensure that any contract entered into by such third-party administrator1 health insurance issuer1 or entity providing pharmacy benefit management services with an applicable entity remit #ajj percent of rebates1 fees1 alternative discounts1 and other remuneration received to the third-party administrator1 health insurance issuer1 or entity providing pharmacy benefit management services4 7#b7 ,form and manner of remittance ,such rebates1 fees1 alternative discounts1 and other remuneration shall be-- 7,a7 remitted to the group health plan or group health insurance coverage in a timely fashion after the period for which such rebates1 fees1 alternative discounts1 or other remuneration is calculated1 and in no case later than #ij days after the end of such period2 7,b7 fully disclosed and enumerated to the group health plan sponsor1 as described in paragraphs 7#a7 and 7#d7 of subsection 7b72 7,c7 available for audit by the plan sponsor1 or a third-party designated by a plan sponsor not less than once per plan year2 and 7,d7 returned to the issuer or entity providing pharmaceutical benefit management services by the group health plan if audits by such issuer or entity indicate that the amounts received are incorrect after such amounts have been paid to the group health plan4 7#c7 ,audit of rebate contracts ,a third-party administrator of a group health plan1 a health insurance issuer offering group health insurance coverage1 or an entity providing pharmacy benefit management services under such health plan or health insurance coverage shall make rebate contracts with rebate aggregators or drug manufacturers available for audit by such plan sponsor or designated third-party1 subject to confidentiality agreements to prevent re-disclosure of such contracts4 7#d7 ,auditors ,the applicable plan sponsor may select an auditor for purposes of carrying out audits under paragraphs 7#b77;,c7 and 7#c74 7#e7 ,rule of construction ,nothing in this subsection shall be construed to prohibit payments to entities offering pharmacy benefit management services for bona fide services using a fee structure not contemplated by this subsection1 provided that such fees are transparent to group health plans and health insurance issuers4 7e7 ,enforcement 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall enforce this section4 7#b7 ,failure to provide timely information ,a health insurance issuer or an entity providing pharmacy benefit management services that violates subsection 7a7 or fails to provide information required under subsection 7b72 a group health plan1 health insurance issuer1 or entity providing pharmacy benefit management services that violates subsection 7c72 or a third-party administrator of a group health plan1 a health insurance issuer offering group health insurance coverage1 or an entity providing pharmacy benefit management services that violates subsection 7d7 shall be subject to a civil monetary penalty in the amount of #aj1jjj for each day during which such violation continues or such information is not disclosed or reported4 7#c7 ,false information ,a health insurance issuer1 entity providing pharmacy benefit management services1 or drug manufacturer that knowingly provides false information under this section shall be subject to a civil money penalty in an amount not to exceed #ajj1jjj for each item of false information4 ,such civil money penalty shall be in addition to other penalties as may be prescribed by law4 7#d7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act1 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such section shall apply to civil monetary penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 7#e7 ,waivers ,the ,secretary may waive penalties under paragraph 7#b71 or extend the period of time for compliance with a requirement of this section1 for an entity in violation of this section that has made a good-faith effort to comply with this section4 7f7 ,rule of construction ,nothing in this section shall be construed to permit a health insurance issuer1 group health plan1 or other entity to restrict disclosure to1 or otherwise limit the access of1 the ,department of ,health and ,human ,services to a report described in subsection 7b77#a7 or information related to compliance with subsection 7a7 by such issuer1 plan1 or entity4 7g7 ,definitions ,in this section-- 7#a7 the term applicable entity means-- 7,a7 a drug manufacturer1 distributor1 wholesaler1 rebate aggregator 7or other purchasing entity designed to aggregate rebates71 group purchasing organization1 or associated third party2 7,b7 any subsidiary1 parent1 affiliate1 or subcontractor of a group health plan1 health insurance issuer1 entity that provides pharmacy benefit management services on behalf of such a plan or issuer1 or any entity described in subparagraph 7,a72 or 7,c7 such other entity as the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury may specify through rulemaking2 7#b7 the term covered group health insurance coverage means health insurance coverage offered in connection with a group health plan maintained by a large employer2 7#c7 the term covered group health plan means a group health plan maintained by a large employer2 7#d7 the term gross spending1 with respect to prescription drug benefits under a group health plan or health insurance coverage1 means the amount spent by a group health plan or health insurance issuer on prescription drug benefits1 calculated before the application of manufacturer rebates1 fees1 alternative discounts1 or other remuneration2 7#e7 the term large employer means1 in connection with a group health plan with respect to a calendar year and a plan year1 an employer who employed an average of at least #ej employees on business days during the preceding calendar year and who employs at least #a employee on the first day of the plan year2 7#f7 the term net spending1 with respect to prescription drug benefits under a group health plan or health insurance coverage1 means the amount spent by a group health plan or health insurance issuer on prescription drug benefits1 calculated after the application of manufacturer rebates1 fees1 alternative discounts1 or other remuneration2 7#g7 the term plan sponsor has the meaning given such term in section #c7af77;,b7 of the ,employee ,retirement ,income ,security ,act of #aigd2 7#h7 the term remuneration has the meaning given such term by the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury1 through notice and comment rulemaking2 7#i7 the term small employer means1 in connection with a group health plan with respect to a calendar year and a plan year1 an employer who employed an average of at least #a but not more than #di employees on business days during the preceding calendar year and who employs at least #a employee on the first day of the plan year2 and 7#aj7 the term wholesale acquisition cost has the meaning given such term in section #ahdg;,a7c77#f77;,b7 of the ,social ,security ,act4 2 and 7#b7 in section #bgbc 7#db ,u4,s4,c4 #cjj;gg-#bb7-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a71 by inserting 7other than section #bgii;,a-#aa7 after part ,d2 and 7ii7 in paragraph 7#b71 by inserting 7other than section #bgii;,a-#aa7 after part ,d2 7,b7 in subsection 7b7-- 7i7 in paragraph 7#a71 by inserting 7other than section #bgii;,a-#aa7 after part ,d2 7ii7 in paragraph 7#b77;,a71 by inserting 7other than section #bgii;,a-#aa7 after part ,d2 and 7iii7 in paragraph 7#b77;,c77ii71 by inserting 7other than section #bgii;,a-#aa7 after part ,d4 7b7 ,,erisa 7#a7 ,in general ,subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajba et seq47 is amended-- 7,a7 in subpart ,b of part #g 7#bi ,u4,s4,c4 #aahe et seq471 by adding at the end the following3 #gbf4 ,oversight of entities that provide pharmacy benefit management services 7a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a group health plan 7or health insurance issuer offering group health insurance coverage in connection with such a plan7 or an entity providing pharmacy benefit management services on behalf of such a plan or issuer shall not enter into a contract with an applicable entity that limits the disclosure of information to plan sponsors in such a manner that prevents the plan or issuer1 or an entity providing pharmacy benefit management services on behalf of a plan or issuer1 from making the reports described in subsection 7b74 7b7 ,reports 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 not less frequently than annually1 an entity providing pharmacy benefit management services on behalf of a covered group health plan shall submit to the plan sponsor of such covered group health plan a report in accordance with this subsection and make such report available to the plan sponsor in a machine-readable format and1 as the ,secretary may determine1 other formats4 ,each such report shall include1 with respect to the covered group health plan-- 7,a7 as applicable1 information collected from drug manufacturers by such issuer or entity on the total amount of copayment assistance dollars paid1 or copayment cards applied1 that were funded by the drug manufacturer with respect to the participants and beneficiaries in such plan2 7,b7 a list of each drug covered by such plan or entity providing pharmacy benefit management services that was billed during the reporting period1 including1 with respect to each such drug during the reporting period-- 7i7 the brand name1 generic or nonproprietary name1 and ,national ,drug ,code2 7ii7 the number of participants and beneficiaries for whom the drug was billed during the reporting period1 the total number of prescription claims for the drug 7including original prescriptions and refills71 and the total number of dosage units of the drug dispensed across the reporting period2 7iii7 for each claim or dosage unit described in clause 7ii71 the type of dispensing channel used1 such as retail1 mail order1 or specialty pharmacy2 7iv7 the wholesale acquisition cost1 listed as cost per days supply1 cost per dosage unit1 and cost per typical course of treatment 7as applicable72 7v7 the total out-of-pocket spending by participants and beneficiaries on such drug after application of any benefits under the plan or coverage1 including participant and beneficiary spending through copayments1 coinsurance1 and deductibles1 but not including any amounts spent by participants and beneficiaries on drugs not covered under the plan or coverage or for which no claim is submitted to the plan or coverage2 and 7vi7 for any drug for which gross spending by the plan exceeded #aj1jjj and that is one of the #ej prescription drugs for which the group health plan spent the most on prescription drug benefits during the reporting period-- 7,i7 a list of all other drugs in the same therapeutic class1 including brand name drugs and biological products and generic drugs or biosimilar biological products that are in the same therapeutic class as such drug2 and 7,,ii7 if applicable1 the rationale for preferred formulary placement of such drug in that therapeutic class1 selected from a list of standard rationales established by the ,secretary2 7,c7 a list of each therapeutic class of drugs that were dispensed under the health plan during the reporting period1 and1 with respect to each such therapeutic class of drugs1 during the reporting period-- 7i7 total gross spending by the plan1 before rebates1 fees1 alternative discounts1 or other remuneration2 7ii7 the number of participants and beneficiaries who filled a prescription for a drug in that class2 7iii7 if applicable to that class1 a description of the formulary tiers and utilization management mechanisms 7such as prior authorization or step therapy7 employed for drugs in that class2 7iv7 the total out-of-pocket spending by participants and beneficiaries1 including participant and beneficiary spending through copayments1 coinsurance1 and deductibles2 and 7v7 for each therapeutic class under which #c or more drugs are included on the formulary of such plan-- 7,i7 the amount received1 or expected to be received1 by such entity1 from an applicable entity1 in rebates1 fees1 alternative discounts1 or other remuneration that-- 7aa7 has been paid1 or will be paid1 by such an applicable entity for claims incurred during the reporting period2 or 7bb7 is related to utilization of drugs or drug spending2 7,,ii7 the total net spending by the health plan on that class of drugs2 and 7,,iii7 the net price per typical course of treatment or #cj-;day supply incurred by the health plan and its participants and beneficiaries1 after rebates1 fees1 alternative discounts1 or other remuneration provided by an applicable entity1 for drugs dispensed within such therapeutic class during the reporting period2 7,d7 total gross spending on prescription drugs by the plan during the reporting period1 before rebates1 fees1 alternative discounts1 or other remuneration provided by an applicable entity2 7,e7 the total amount received1 or expected to be received1 by the health plan1 from an applicable entity1 in rebates1 fees1 alternative discounts1 and other remuneration received from any such entities1 related to utilization of drug or drug spending under that health plan during the reporting period2 7,f7 the total net spending on prescription drugs by the health plan during the reporting period2 7,g7 amounts paid directly or indirectly in rebates1 fees1 or any other type of compensation 7as defined in section #djh7;b77#b77;,b77ii77dd77,,aa77 to brokers1 consultants1 advisors1 or any other individual or firm who referred the group health plan's business to the pharmacy benefit manager2 and 7,h7 a summary document that includes such information described in subparagraphs 7,a7 through 7,g7 as the ,secretary determines useful for plan sponsors for purposes of selecting pharmacy benefit management services1 such as an estimated net price to plan sponsor and participant or beneficiary1 a cost per claim1 the fee structure or reimbursement model1 and estimated cost per participant or beneficiary4 7#b7 ,supplementary reporting for intra-company prescription drug transactions 7,a7 ,in general ,a health insurance issuer offering covered group health insurance coverage or an entity providing pharmacy benefit management services under a covered group health plan or covered group health insurance coverage shall submit1 together with the report under paragraph 7#a71 a supplementary report every #f months to the plan sponsor that includes-- 7i7 an explanation of any benefit design parameters that encourage or require participants and beneficiaries in the plan or coverage to fill prescriptions at mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by that issuer or entity providing pharmacy benefit management services under such plan or coverage1 including mandatory mail and specialty home delivery programs1 retail and mail auto-refill programs1 and copayment incentives funded by an entity providing pharmacy benefit management services2 7ii7 the percentage of total prescriptions charged to the plan1 coverage1 or participants and beneficiaries in the plan or coverage1 that were dispensed by mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by the issuer or entity providing pharmacy benefit management services2 and 7iii7 a list of all drugs dispensed by such wholly or partially-owned pharmacy and charged to the plan or coverage1 or participants and beneficiaries of the plan or coverage1 during the applicable quarter1 and1 with respect to each drug-- 7,i7 the amounts charged1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 with respect to participants and beneficiaries in the plan or coverage1 including amounts charged to the plan or coverage and amounts charged to the participants and beneficiaries2 7,,ii7 the median amount charged to the plan or coverage1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 including amounts paid by the participants and beneficiaries1 when the same drug is dispensed by other pharmacies that are not wholly or partially-owned by the issuer or entity and that are included in the pharmacy network of that plan or coverage2 7,,iii7 the interquartile range of the costs1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 including amounts paid by the participants and beneficiaries1 when the same drug is dispensed by other pharmacies that are not wholly or partially-owned by the issuer or entity and that are included in the pharmacy network of that plan or coverage2 7,,iv7 the lowest cost1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 for such drug1 including amounts charged to the plan or issuer and participants and beneficiaries1 that is available from any pharmacy included in the network of the plan or coverage2 7,v7 the net acquisition cost per dosage unit and for a #cj day-supply1 and the acquisition cost per typical course of treatment1 if the drug is subject to a maximum price discount2 and 7,,vi7 other information with respect to the cost of the drug1 as determined by the ,secretary1 such as average sales price1 wholesale acquisition cost1 and national average drug acquisition cost per dosage unit1 per typical course of treatment1 or per #cj-;day supply1 for such drug1 including amounts charged to the plan or issuer and participants and beneficiaries among all pharmacies included in the network of the plan or coverage4 7,b7 ,plans and coverage offered by small employers ,a health insurance issuer offering covered group health insurance coverage that is not covered group health insurance coverage or an entity providing pharmacy benefit management services under a group health plan that is not a covered group health plan or under group health insurance coverage that is not covered group health insurance coverage that conducts transactions with a wholly or partially-owned pharmacy shall submit1 together with the report under paragraph 7#a71 a supplementary report every #f months to the plan sponsor that includes the information described in clauses 7i7 and 7ii7 of subparagraph 7,a74 7#c7 ,privacy requirements 7,a7 ,relationship to ,,hipaa regulations ,nothing in this section shall be construed to modify the requirements for the creation1 receipt1 maintenance1 or transmission of protected health information under the privacy1 security1 breach notification1 and enforcement regulations in parts #afj and #afd of title #de1 ,code of ,federal ,regulations 7or successor regulations74 7,b7 ,requirement ,a report submitted under paragraph 7#a7 or 7#b7 shall contain only summary health information1 as defined in section #afd4ejd7;a7 of title #de1 ,code of ,federal ,regulations 7or successor regulations74 7,c7 ,clarification regarding certain disclosures of information 7i7 ,reasonable restrictions ,nothing in this section prevents a health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of a group health plan or group health insurance coverage from placing reasonable restrictions on the public disclosure of the information contained in a report under paragraph 7#a7 or 7#b74 7ii7 ,limitations ,a health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of a group health plan or group health insurance coverage may not restrict disclosure of such reports to the ,department of ,health and ,human ,services1 the ,department of ,labor1 the ,department of the ,treasury1 or any other ,federal agency responsible for enforcement activities under this section for purposes of enforcement under this section or other applicable law1 or to the ,comptroller ,general of the ,united ,states in accordance with paragraph 7#f74 7#d7 ,use and disclosure by plan sponsors 7,a7 ,prohibition ,a plan sponsor may not-- 7i7 fail or refuse to hire1 or discharge1 any employee1 or otherwise discriminate against any employee with respect to the compensation1 terms1 conditions1 or privileges of employment of the employee1 because of information submitted under paragraph 7#a7 or 7#b7 attributed to the employee or a dependent of the employee2 or 7ii7 limit1 segregate1 or classify the employees of the employer in any way that would deprive or tend to deprive any employee of employment opportunities or otherwise adversely affect the status of the employee as an employee1 because of information submitted under paragraph 7#a7 or 7#b7 attributed to the employee or a dependent of the employee4 7,b7 ,disclosure and redisclosure ,a plan sponsor shall not disclose the information received under paragraph 7#a7 or 7#b7 except-- 7i7 to an occupational or other health researcher if the research is conducted in compliance with the regulations and protections provided for under part #df of title #de1 ,code of ,federal ,regulations 7or successor regulations72 7ii7 in response to an order of a court1 except that the plan sponsor may disclose only the information expressly authorized by such order2 7iii7 to the ,department of ,health and ,human ,services1 the ,department of ,labor1 the ,department of the ,treasury1 or other ,federal agency responsible for enforcement activities under this section2 or 7iv7 to a contractor or agent for purposes of health plan administration1 if such contractor or agent agrees1 in writing1 to abide by the same use and disclosure restrictions as the plan sponsor4 7,c7 ,relationship to ,,hipaa regulations ,with respect to the regulations promulgated by the ,secretary of ,health and ,human ,services under part ,c of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d et seq47 and section #bfd of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b71 subparagraph 7,b7 does not prohibit a covered entity 7as defined for purposes of such regulations7 from any use or disclosure of health information that is authorized for the covered entity under such regulations4 ,the previous sentence does not affect the authority of such ,secretary to modify such regulations4 7,d7 ,enforcement 7i7 ,in general ,the powers1 procedures1 and remedies provided in section #bjg of the ,genetic ,information ,nondiscrimination ,act 7#db ,u4,s4,c4 #bjjj;ff-#f7 to a person alleging a violation of title ,,ii of such ,act shall be the powers1 procedures1 and remedies this subparagraph provides for any person alleging a violation of this paragraph4 7ii7 ,prohibition against retaliation ,no person shall discriminate against any individual because such individual has opposed any act or practice made unlawful by this paragraph or because such individual made a charge1 testified1 assisted1 or participated in any manner in an investigation1 proceeding1 or hearing under this paragraph4 ,the remedies and procedures otherwise provided for under this subparagraph shall be available to aggrieved individuals with respect to violations of this clause4 7#e7 ,additional reporting 7,a7 ,reporting with respect to group health plans offered by small employers ,for plan years beginning on or after ,january #a1 #bjbe1 not less frequently than annually1 an entity providing pharmacy benefit management services on behalf of a group health plan that is not a covered group health plan shall submit to the plan sponsor of such group health plan a report in accordance with this paragraph1 and make such report available to the plan sponsor in a machine-readable format1 and such other formats as the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor may determine4 ,each such report shall include1 with respect to the applicable group health plan1 the information described in subparagraphs 7,a71 7,d71 7,e71 7,f71 7,g71 and 7,h7 of paragraph 7#a74 7,b7 ,opt-in for group health insurance coverage 7i7 ,in general ,a plan sponsor may1 on an annual basis1 beginning with plan years beginning on or after ,january #a1 #bjbe1 elect to require a health insurance issuer offering group health insurance coverage to submit to such plan sponsor a report in accordance with this subsection4 7ii7 ,contents of reports 7,i7 ,covered group health insurance coverage ,in the case of an issuer that offers covered group health insurance coverage1 a report provided pursuant to clause 7i7 shall include1 with respect to the applicable covered group health insurance coverage1 the information required under paragraph 7#a7 for covered group health plans4 7,,ii7 ,other group health insurance coverage ,in the case of an issuer that offers group health insurance coverage that is not covered group health insurance1 a report provided pursuant to clause 7i7 shall include1 with respect to the applicable group health insurance coverage1 the information described in subparagraphs 7,a71 7,d71 7,e71 7,f71 and 7,g7 of paragraph 7#a74 7iii7 ,application ,for purposes of reports submitted in accordance with this subparagraph1 paragraph 7#a7 shall be applied by substituting group health insurance coverage or health insurance issuer1 as applicable1 for group health plan1 group plan1 and plan where such terms appear in such paragraph4 7iv7 ,required reporting for all group health insurance coverage ,each health insurance issuer of health insurance coverage shall annually submit the information described in paragraph 7#a77;,h71 regardless of whether the plan sponsor made the election described in clause 7i7 for the applicable year4 7#f7 ,submissions to ,,gao ,a health insurance issuer offering group health insurance coverage or an entity providing pharmacy benefit management services on behalf of a group health plan shall submit to the ,comptroller ,general of the ,united ,states each of the first #b reports submitted to a plan sponsor under paragraph 7#a7 or 7#e7 with respect to such coverage or plan1 and other such reports as requested1 in accordance with the privacy requirements under paragraph 7#c71 and such other information that the ,comptroller ,general determines necessary to carry out the study under section #b7;f7 of the ,pharmacy ,benefit ,manager ,reform ,act4 7#g7 ,standard formats 7,a7 ,in general ,not later than ,june #a1 #bjbd1 the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall specify1 through rulemaking1 standard formats for health insurance issuers and entities providing pharmacy benefit management services to submit reports required under this subsection4 7,b7 ,limited form of report ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall define through rulemaking a limited form of the reports under paragraphs 7#a7 and 7#b7 required to be submitted to plan sponsors who also are drug manufacturers1 drug wholesalers1 entities providing pharmacy benefit management services1 or other direct participants in the drug supply chain1 in order to prevent anti-competitive behavior4 7c7 ,limitations on spread pricing 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a group health plan or health insurance issuer offering group health insurance coverage shall not charge participants and beneficiaries1 and an entity providing pharmacy benefit management services under such a plan or coverage shall not charge the plan1 issuer1 or participants and beneficiaries1 a price for a prescription drug that exceeds the price paid to the pharmacy for such drug1 excluding penalties paid by the pharmacy 7as described in paragraph 7#b77 to such plan1 issuer1 or entity4 7#b7 ,rule of construction ,for purposes of paragraph 7#a71 penalties paid by pharmacies include only the following3 7,a7 ,a penalty paid if an original claim for a prescription drug was submitted fraudulently by the pharmacy to the plan1 issuer1 or entity4 7,b7 ,a penalty paid if the original claim payment made by the plan1 issuer1 or entity to the pharmacy was inconsistent with the reimbursement terms in any contract between the pharmacy and the plan1 issuer1 or entity4 7,c7 ,a penalty paid if the pharmacist services billed to the plan1 issuer1 or entity were not rendered by the pharmacy4 7d7 ,full rebate pass-,through to plan 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a third-party administrator of a group health plan1 a health insurance issuer offering group health insurance coverage1 or an entity providing pharmacy benefit management services under such health plan or health insurance coverage shall-- 7,a7 remit #ajj percent of rebates1 fees1 alternative discounts1 and other applicable remuneration received from any applicable entity that are related to utilization of drugs under such health plan or health insurance coverage1 to the group health plan2 and 7,b7 ensure that any contract entered into by such third-party administrator1 health insurance issuer1 or entity providing pharmacy benefit management services with an applicable entity remit #ajj percent of rebates1 fees1 alternative discounts1 and other remuneration received to the third-party administrator1 health insurance issuer1 or entity providing pharmacy benefit management services4 7#b7 ,form and manner of remittance ,such rebates1 fees1 alternative discounts1 and other remuneration shall be-- 7,a7 remitted to the group health plan or group health insurance coverage in a timely fashion after the period for which such rebates1 fees1 alternative discounts1 or other remuneration is calculated1 and in no case later than #ij days after the end of such period2 7,b7 fully disclosed and enumerated to the group health plan sponsor1 as described in paragraphs 7#a7 and 7#d7 of subsection 7b72 7,c7 available for audit by the plan sponsor1 or a third-party designated by a plan sponsor not less than once per plan year2 and 7,d7 returned to the issuer or entity providing pharmaceutical benefit management services by the group health plan if audits by such issuer or entity indicate that the amounts received are incorrect after such amounts have been paid to the group health plan4 7#c7 ,audit of rebate contracts ,a third-party administrator of a group health plan1 a health insurance issuer offering group health insurance coverage1 or an entity providing pharmacy benefit management services under such health plan or health insurance coverage shall make rebate contracts with rebate aggregators or drug manufacturers available for audit by such plan sponsor or designated third-party1 subject to confidentiality agreements to prevent re-disclosure of such contracts4 7#d7 ,auditors ,the applicable plan sponsor may select an auditor for purposes of carrying out audits under paragraphs 7#b77;,c7 and 7#c74 7#e7 ,rule of construction ,nothing in this subsection shall be construed to prohibit payments to entities offering pharmacy benefit management services for bona fide services using a fee structure not contemplated by this subsection1 provided that such fees are transparent to group health plans and health insurance issuers4 7e7 ,enforcement 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury1 shall enforce this section4 7#b7 ,failure to provide timely information ,a health insurance issuer or an entity providing pharmacy benefit management services that violates subsection 7a7 or fails to provide information required under subsection 7b72 a group health plan1 health insurance issuer1 or entity providing pharmacy benefit management services that violates subsection 7c72 or a third-party administrator of a group health plan1 a health insurance issuer offering group health insurance coverage1 or an entity providing pharmacy benefit management services that violates subsection 7d7 shall be subject to a civil monetary penalty in the amount of #aj1jjj for each day during which such violation continues or such information is not disclosed or reported4 7#c7 ,false information ,a health insurance issuer1 entity providing pharmacy benefit management services1 or drug manufacturer that knowingly provides false information under this section shall be subject to a civil money penalty in an amount not to exceed #ajj1jjj for each item of false information4 ,such civil money penalty shall be in addition to other penalties as may be prescribed by law4 7#d7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act1 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such section shall apply to civil monetary penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 7#e7 ,waivers ,the ,secretary may waive penalties under paragraph 7#b71 or extend the period of time for compliance with a requirement of this section1 for an entity in violation of this section that has made a good-faith effort to comply with this section4 7f7 ,rule of construction ,nothing in this section shall be construed to permit a health insurance issuer1 group health plan1 or other entity to restrict disclosure to1 or otherwise limit the access of1 the ,department of ,labor to a report described in subsection 7b77#a7 or information related to compliance with subsection 7a7 by such issuer1 plan1 or entity4 7g7 ,definitions ,in this section-- 7#a7 the term applicable entity means-- 7,a7 a drug manufacturer1 distributor1 wholesaler1 rebate aggregator 7or other purchasing entity designed to aggregate rebates71 group purchasing organization1 or associated third party2 7,b7 any subsidiary1 parent1 affiliate1 or subcontractor of a group health plan1 health insurance issuer1 entity that provides pharmacy benefit management services on behalf of such a plan or issuer1 or any entity described in subparagraph 7,a72 or 7,c7 such other entity as the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury may specify through rulemaking2 7#b7 the term covered group health insurance coverage means health insurance coverage offered in connection with a group health plan maintained by a large employer2 7#c7 the term covered group health plan means a group health plan maintained by a large employer2 7#d7 the term gross spending1 with respect to prescription drug benefits under a group health plan or health insurance coverage1 means the amount spent by a group health plan or health insurance issuer on prescription drug benefits1 calculated before the application of manufacturer rebates1 fees1 alternative discounts1 or other remuneration2 7#e7 the term large employer means1 in connection with a group health plan with respect to a calendar year and a plan year1 an employer who employed an average of at least #ej employees on business days during the preceding calendar year and who employs at least #a employee on the first day of the plan year2 7#f7 the term net spending1 with respect to prescription drug benefits under a group health plan or health insurance coverage1 means the amount spent by a group health plan or health insurance issuer on prescription drug benefits1 calculated after the application of manufacturer rebates1 fees1 alternative discounts1 or other remuneration2 7#g7 the term plan sponsor has the meaning given such term in section #c7af77;,b72 7#h7 the term remuneration has the meaning given such term by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury1 through notice and comment rulemaking2 7#i7 the term small employer means1 in connection with a group health plan with respect to a calendar year and a plan year1 an employer who employed an average of at least #a but not more than #di employees on business days during the preceding calendar year and who employs at least #a employee on the first day of the plan year2 and 7#aj7 the term wholesale acquisition cost has the meaning given such term in section #ahdg;,a7c77#f77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c;a7c77#f77;,b774 2 and 7,b7 in section #ejb7;b77#c7 7#bi ,u4,s4,c4 #aacb7;b77#c771 by inserting 7other than section #gbf7 after part #g4 7#b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajja et seq47 is amended by inserting after the item relating to section #gbe the following new item3 ,sec4 #gbf4 ,oversight of entities that provide pharmacy benefit management services4 4 7c7 ,internal ,revenue ,code 7#a7 ,in general ,subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following3 #ihbf4 ,oversight of entities that provide pharmacy benefit management services 7a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a group health plan or an entity providing pharmacy benefit management services on behalf of such a plan shall not enter into a contract with an applicable entity that limits the disclosure of information to plan sponsors in such a manner that prevents the plan1 or an entity providing pharmacy benefit management services on behalf of a plan1 from making the reports described in subsection 7b74 7b7 ,reports 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 not less frequently than annually1 an entity providing pharmacy benefit management services on behalf of a covered group health plan shall submit to the plan sponsor of such covered group health plan a report in accordance with this subsection and make such report available to the plan sponsor in a machine-readable format and1 as the ,secretary may determine1 other formats4 ,each such report shall include1 with respect to the covered group health plan-- 7,a7 as applicable1 information collected from drug manufacturers by such entity on the total amount of copayment assistance dollars paid1 or copayment cards applied1 that were funded by the drug manufacturer with respect to the participants and beneficiaries in such plan2 7,b7 a list of each drug covered by such plan or entity providing pharmacy benefit management services that was billed during the reporting period1 including1 with respect to each such drug during the reporting period-- 7i7 the brand name1 generic or nonproprietary name1 and ,national ,drug ,code2 7ii7 the number of participants and beneficiaries for whom the drug was billed during the reporting period1 the total number of prescription claims for the drug 7including original prescriptions and refills71 and the total number of dosage units of the drug dispensed across the reporting period2 7iii7 for each claim or dosage unit described in clause 7ii71 the type of dispensing channel used1 such as retail1 mail order1 or specialty pharmacy2 7iv7 the wholesale acquisition cost1 listed as cost per days supply1 cost per dosage unit1 and cost per typical course of treatment 7as applicable72 7v7 the total out-of-pocket spending by participants and beneficiaries on such drug after application of any benefits under the plan1 including participant and beneficiary spending through copayments1 coinsurance1 and deductibles1 but not including any amounts spent by participants and beneficiaries on drugs not covered under the plan or for which no claim is submitted to the plan2 and 7vi7 for any drug for which gross spending by the plan exceeded #aj1jjj and that is one of the #ej prescription drugs for which the group health plan spent the most on prescription drug benefits during the reporting period-- 7,i7 a list of all other drugs in the same therapeutic class1 including brand name drugs and biological products and generic drugs or biosimilar biological products that are in the same therapeutic class as such drug2 and 7,,ii7 if applicable1 the rationale for preferred formulary placement of such drug in that therapeutic class1 selected from a list of standard rationales established by the ,secretary2 7,c7 a list of each therapeutic class of drugs that were dispensed under the health plan during the reporting period1 and1 with respect to each such therapeutic class of drugs1 during the reporting period-- 7i7 total gross spending by the plan1 before rebates1 fees1 alternative discounts1 or other remuneration2 7ii7 the number of participants and beneficiaries who filled a prescription for a drug in that class2 7iii7 if applicable to that class1 a description of the formulary tiers and utilization management mechanisms 7such as prior authorization or step therapy7 employed for drugs in that class2 7iv7 the total out-of-pocket spending by participants and beneficiaries1 including participant and beneficiary spending through copayments1 coinsurance1 and deductibles2 and 7v7 for each therapeutic class under which #c or more drugs are included on the formulary of such plan-- 7,i7 the amount received1 or expected to be received1 by such entity1 from an applicable entity1 in rebates1 fees1 alternative discounts1 or other remuneration that-- 7aa7 has been paid1 or will be paid1 by such an applicable entity for claims incurred during the reporting period2 or 7bb7 is related to utilization of drugs or drug spending2 7,,ii7 the total net spending by the health plan on that class of drugs2 and 7,,iii7 the net price per typical course of treatment or #cj-;day supply incurred by the health plan and its participants and beneficiaries1 after rebates1 fees1 alternative discounts1 or other remuneration provided by an applicable entity1 for drugs dispensed within such therapeutic class during the reporting period2 7,d7 total gross spending on prescription drugs by the plan during the reporting period1 before rebates1 fees1 alternative discounts1 or other remuneration provided by an applicable entity2 7,e7 the total amount received1 or expected to be received1 by the health plan1 from an applicable entity1 in rebates1 fees1 alternative discounts1 and other remuneration received from any such entities1 related to utilization of drug or drug spending under that health plan during the reporting period2 7,f7 the total net spending on prescription drugs by the health plan during the reporting period2 7,g7 amounts paid directly or indirectly in rebates1 fees1 or any other type of compensation 7as defined in section #djh7;b77#b77;,b77ii77dd77,,aa7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aajh7;b77#b77;,b77ii77dd77,a777 to brokers1 consultants1 advisors1 or any other individual or firm who referred the group health plan's business to the pharmacy benefit manager2 and 7,h7 a summary document that includes such information described in subparagraphs 7,a7 through 7,g7 as the ,secretary determines useful for plan sponsors for purposes of selecting pharmacy benefit management services1 such as an estimated net price to plan sponsor and participant or beneficiary1 a cost per claim1 the fee structure or reimbursement model1 and estimated cost per participant or beneficiary4 7#b7 ,supplementary reporting for intra-company prescription drug transactions 7,a7 ,in general ,an entity providing pharmacy benefit management services under a covered group health plan shall submit1 together with the report under paragraph 7#a71 a supplementary report every #f months to the plan sponsor that includes-- 7i7 an explanation of any benefit design parameters that encourage or require participants and beneficiaries in the plan to fill prescriptions at mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by that entity providing pharmacy benefit management services under such plan1 including mandatory mail and specialty home delivery programs1 retail and mail auto-refill programs1 and copayment incentives funded by an entity providing pharmacy benefit management services2 7ii7 the percentage of total prescriptions charged to the plan or participants and beneficiaries in the plan1 that were dispensed by mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by the entity providing pharmacy benefit management services2 and 7iii7 a list of all drugs dispensed by such wholly or partially-owned pharmacy and charged to the plan1 or participants and beneficiaries of the plan1 during the applicable quarter1 and1 with respect to each drug-- 7,i7 the amounts charged1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 with respect to participants and beneficiaries in the plan1 including amounts charged to the plan and amounts charged to the participants and beneficiaries2 7,,ii7 the median amount charged to the plan1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 including amounts paid by the participants and beneficiaries1 when the same drug is dispensed by other pharmacies that are not wholly or partially-owned by the entity and that are included in the pharmacy network of that plan2 7,,iii7 the interquartile range of the costs1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 including amounts paid by the participants and beneficiaries1 when the same drug is dispensed by other pharmacies that are not wholly or partially-owned by the entity and that are included in the pharmacy network of that plan2 7,,iv7 the lowest cost1 per dosage unit1 per course of treatment1 per #cj-;day supply1 and per #ij-;day supply1 for such drug1 including amounts charged to the plan and participants and beneficiaries1 that is available from any pharmacy included in the network of the plan2 7,v7 the net acquisition cost per dosage unit and for a #cj day-supply1 and the acquisition cost per typical course of treatment1 if the drug is subject to a maximum price discount2 and 7,,vi7 other information with respect to the cost of the drug1 as determined by the ,secretary1 such as average sales price1 wholesale acquisition cost1 and national average drug acquisition cost per dosage unit1 per typical course of treatment1 or per #cj-;day supply1 for such drug1 including amounts charged to the plan and participants and beneficiaries among all pharmacies included in the network of the plan4 7,b7 ,plans offered by small employers ,an entity providing pharmacy benefit management services under a group health plan that is not a covered group health plan that conducts transactions with a wholly or partially-owned pharmacy shall submit1 together with the report under paragraph 7#a71 a supplementary report every #f months to the plan sponsor that includes the information described in clauses 7i7 and 7ii7 of subparagraph 7,a74 7#c7 ,privacy requirements 7,a7 ,relationship to ,,hipaa regulations ,nothing in this section shall be construed to modify the requirements for the creation1 receipt1 maintenance1 or transmission of protected health information under the privacy1 security1 breach notification1 and enforcement regulations in parts #afj and #afd of title #de1 ,code of ,federal ,regulations 7or successor regulations74 7,b7 ,requirement ,a report submitted under paragraph 7#a7 or 7#b7 shall contain only summary health information1 as defined in section #afd4ejd7;a7 of title #de1 ,code of ,federal ,regulations 7or successor regulations74 7,c7 ,clarification regarding certain disclosures of information 7i7 ,reasonable restrictions ,nothing in this section prevents an entity providing pharmacy benefit management services on behalf of a group health plan from placing reasonable restrictions on the public disclosure of the information contained in a report under paragraph 7#a7 or 7#b74 7ii7 ,limitations ,an entity providing pharmacy benefit management services on behalf of a group health plan or group health insurance coverage may not restrict disclosure of such reports to the ,department of ,health and ,human ,services1 the ,department of ,labor1 the ,department of the ,treasury1 or any other ,federal agency responsible for enforcement activities under this section for purposes of enforcement under this section or other applicable law1 or to the ,comptroller ,general of the ,united ,states in accordance with paragraph 7#f74 7#d7 ,use and disclosure by plan sponsors 7,a7 ,prohibition ,a plan sponsor may not-- 7i7 fail or refuse to hire1 or discharge1 any employee1 or otherwise discriminate against any employee with respect to the compensation1 terms1 conditions1 or privileges of employment of the employee1 because of information submitted under paragraph 7#a7 or 7#b7 attributed to the employee or a dependent of the employee2 or 7ii7 limit1 segregate1 or classify the employees of the employer in any way that would deprive or tend to deprive any employee of employment opportunities or otherwise adversely affect the status of the employee as an employee1 because of information submitted under paragraph 7#a7 or 7#b7 attributed to the employee or a dependent of the employee4 7,b7 ,disclosure and redisclosure ,a plan sponsor shall not disclose the information received under paragraph 7#a7 or 7#b7 except-- 7i7 to an occupational or other health researcher if the research is conducted in compliance with the regulations and protections provided for under part #df of title #de1 ,code of ,federal ,regulations 7or successor regulations72 7ii7 in response to an order of a court1 except that the plan sponsor may disclose only the information expressly authorized by such order2 7iii7 to the ,department of ,health and ,human ,services1 the ,department of ,labor1 the ,department of the ,treasury1 or other ,federal agency responsible for enforcement activities under this section2 or 7iv7 to a contractor or agent for purposes of health plan administration1 if such contractor or agent agrees1 in writing1 to abide by the same use and disclosure restrictions as the plan sponsor4 7,c7 ,relationship to ,,hipaa regulations ,with respect to the regulations promulgated by the ,secretary of ,health and ,human ,services under part ,c of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d et seq47 and section #bfd of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b71 subparagraph 7,b7 does not prohibit a covered entity 7as defined for purposes of such regulations7 from any use or disclosure of health information that is authorized for the covered entity under such regulations4 ,the previous sentence does not affect the authority of such ,secretary to modify such regulations4 7,d7 ,enforcement 7i7 ,in general ,the powers1 procedures1 and remedies provided in section #bjg of the ,genetic ,information ,nondiscrimination ,act 7#db ,u4,s4,c4 #bjjj;ff-#f7 to a person alleging a violation of title ,,ii of such ,act shall be the powers1 procedures1 and remedies this subparagraph provides for any person alleging a violation of this paragraph4 7ii7 ,prohibition against retaliation ,no person shall discriminate against any individual because such individual has opposed any act or practice made unlawful by this paragraph or because such individual made a charge1 testified1 assisted1 or participated in any manner in an investigation1 proceeding1 or hearing under this paragraph4 ,the remedies and procedures otherwise provided for under this subparagraph shall be available to aggrieved individuals with respect to violations of this clause4 7#e7 ,reporting with respect to group health plans offered by small employers ,for plan years beginning on or after ,january #a1 #bjbe1 not less frequently than annually1 an entity providing pharmacy benefit management services on behalf of a group health plan that is not a covered group health plan shall submit to the plan sponsor of such group health plan a report in accordance with this paragraph1 and make such report available to the plan sponsor in a machine-readable format4 ,each such report shall include1 with respect to the applicable group health plan1 the information described in subparagraphs 7,a71 7,d71 7,e71 7,f71 7,g71 and 7,h7 of paragraph 7#a74 7#f7 ,submissions to ,,gao ,an entity providing pharmacy benefit management services on behalf of a group health plan shall submit to the ,comptroller ,general of the ,united ,states each of the first #b reports submitted to a plan sponsor under paragraph 7#a7 or 7#e7 with respect to such plan1 and other such reports as requested1 in accordance with the privacy requirements under paragraph 7#c71 and such other information that the ,comptroller ,general determines necessary to carry out the study under section #b7;f7 of the ,pharmacy ,benefit ,manager ,reform ,act4 7#g7 ,standard formats 7,a7 ,in general ,not later than ,june #a1 #bjbd1 the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor shall specify1 through rulemaking1 standard formats for health insurance issuers and entities providing pharmacy benefit management services to submit reports required under this subsection4 7,b7 ,limited form of report ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor shall define through rulemaking a limited form of the reports under paragraphs 7#a7 and 7#b7 required to be submitted to plan sponsors who also are drug manufacturers1 drug wholesalers1 entities providing pharmacy benefit management services1 or other direct participants in the drug supply chain1 in order to prevent anti-competitive behavior4 7c7 ,limitations on spread pricing 7#a7 ,in general ,a group health plan shall not charge participants and beneficiaries1 and an entity providing pharmacy benefit management services under such a plan shall not charge the plan or participants and beneficiaries1 a price for a prescription drug that exceeds the price paid to the pharmacy for such drug1 excluding penalties paid by the pharmacy 7as described in paragraph 7#b77 to such plan or entity4 7#b7 ,rule of construction ,for purposes of paragraph 7#a71 penalties paid by pharmacies include only the following3 7,a7 ,a penalty paid if an original claim for a prescription drug was submitted fraudulently by the pharmacy to the plan or entity4 7,b7 ,a penalty paid if the original claim payment made by the plan1 issuer1 or entity to the pharmacy was inconsistent with the reimbursement terms in any contract between the pharmacy and the plan or entity4 7,c7 ,a penalty paid if the pharmacist services billed to the plan or entity were not rendered by the pharmacy4 7d7 ,full rebate pass-,through to plan 7#a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 a third-party administrator of a group health plan or an entity providing pharmacy benefit management services under such health plan shall-- 7,a7 remit #ajj percent of rebates1 fees1 alternative discounts1 and other remuneration received from any applicable entity that are related to utilization of drugs under such health plan1 to the group health plan2 and 7,b7 ensure that any contract entered into by such third-party administrator or entity providing pharmacy benefit management services with an applicable entity remit #ajj percent of rebates1 fees1 alternative discounts1 and other remuneration received to the third-party administrator or entity providing pharmacy benefit management services4 7#b7 ,form and manner of remittance ,such rebates1 fees1 alternative discounts1 and other remuneration shall be-- 7,a7 remitted to the group health plan in a timely fashion after the period for which such rebates1 fees1 alternative discounts1 or other remuneration is calculated1 and in no case later than #ij days after the end of such period2 7,b7 fully disclosed and enumerated to the group health plan sponsor1 as described in paragraphs 7#a7 and 7#d7 of subsection 7b72 7,c7 available for audit by the plan sponsor1 or a third-party designated by a plan sponsor not less than once per plan year2 and 7,d7 returned to the issuer or entity providing pharmaceutical benefit management services by the group health plan if audits by such entity indicate that the amounts received are incorrect after such amounts have been paid to the group health plan4 7#c7 ,audit of rebate contracts ,a third-party administrator of a group health plan or an entity providing pharmacy benefit management services under such health plan shall make rebate contracts with rebate aggregators or drug manufacturers available for audit by such plan sponsor or designated third-party1 subject to confidentiality agreements to prevent re-disclosure of such contracts4 7#d7 ,auditors ,the applicable plan sponsor may select an auditor for purposes of carrying out audits under paragraphs 7#b77;,c7 and 7#c74 7#e7 ,rule of construction ,nothing in this subsection shall be construed to prohibit payments to entities offering pharmacy benefit management services for bona fide services using a fee structure not contemplated by this subsection1 provided that such fees are transparent to group health plans4 7e7 ,enforcement 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,labor and the ,secretary of ,health and ,human ,services1 shall enforce this section4 7#b7 ,failure to provide timely information ,a health insurance issuer or an entity providing pharmacy benefit management services that violates subsection 7a7 or fails to provide information required under subsection 7b72 a group health plan or entity providing pharmacy benefit management services that violates subsection 7c72 or a third-party administrator of a group health plan or an entity providing pharmacy benefit management services that violates subsection 7d7 shall be subject to a civil monetary penalty in the amount of #aj1jjj for each day during which such violation continues or such information is not disclosed or reported4 7#c7 ,false information ,an entity providing pharmacy benefit management services1 or drug manufacturer that knowingly provides false information under this section shall be subject to a civil money penalty in an amount not to exceed #ajj1jjj for each item of false information4 ,such civil money penalty shall be in addition to other penalties as may be prescribed by law4 7#d7 ,procedure ,the provisions of section #aabh;,a of the ,social ,security ,act1 other than subsections 7a7 and 7b7 and the first sentence of subsection 7c77#a7 of such section shall apply to civil monetary penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a of the ,social ,security ,act4 7#e7 ,waivers ,the ,secretary may waive penalties under paragraph 7#b71 or extend the period of time for compliance with a requirement of this section1 for an entity in violation of this section that has made a good-faith effort to comply with this section4 7f7 ,rule of construction ,nothing in this section shall be construed to permit a group health plan or other entity to restrict disclosure to1 or otherwise limit the access of1 the ,department of the ,treasury to a report described in subsection 7b77#a7 or information related to compliance with subsection 7a7 by such plan or entity4 7g7 ,definitions ,in this section-- 7#a7 the term applicable entity means-- 7,a7 a drug manufacturer1 distributor1 wholesaler1 rebate aggregator 7or other purchasing entity designed to aggregate rebates71 group purchasing organization1 or associated third party2 7,b7 any subsidiary1 parent1 affiliate1 or subcontractor of a group health plan1 health insurance issuer1 entity that provides pharmacy benefit management services on behalf of such a plan or issuer1 or any entity described in subparagraph 7,a72 or 7,c7 such other entity as the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor may specify through rulemaking2 7#b7 the term covered group health insurance coverage means health insurance coverage offered in connection with a group health plan maintained by a large employer2 7#c7 the term covered group health plan means a group health plan maintained by a large employer2 7#d7 the term gross spending1 with respect to prescription drug benefits under a group health plan or health insurance coverage1 means the amount spent by a group health plan or health insurance issuer on prescription drug benefits1 calculated before the application of manufacturer rebates1 fees1 alternative discounts1 or other remuneration2 7#e7 the term large employer means1 in connection with a group health plan with respect to a calendar year and a plan year1 an employer who employed an average of at least #ej employees on business days during the preceding calendar year and who employs at least #a employee on the first day of the plan year2 7#f7 the term net spending1 with respect to prescription drug benefits under a group health plan or health insurance coverage1 means the amount spent by a group health plan or health insurance issuer on prescription drug benefits1 calculated after the application of manufacturer rebates1 fees1 alternative discounts1 or other remuneration2 7#g7 the term plan sponsor has the meaning given such term in section #c7af77;,b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb7af77;,b772 7#h7 the term remuneration has the meaning given such term by the ,secretary1 the ,secretary of ,labor1 and the ,secretary of ,health and ,human ,services1 through notice and comment rulemaking2 7#i7 the term small employer means1 in connection with a group health plan with respect to a calendar year and a plan year1 an employer who employed an average of at least #a but not more than #di employees on business days during the preceding calendar year and who employs at least #a employee on the first day of the plan year2 and 7#aj7 the term wholesale acquisition cost has the meaning given such term in section #ahdg;,a7c77#f77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c;a7c77#f77;,b774 4 7#b7 ,clerical amendment ,the table of sections for subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new item3 ,sec4 #ihbf4 ,oversight of entities that provide pharmacy benefit management services4 4 7d7 ,funding 7#a7 ,for purposes of carrying out the amendments made by subsection 7a71 there are appropriated to the ,centers for ,medicare ,medicaid ,services1 out of amounts in the ,treasury not otherwise appropriated1 #hj1jjj1jjj for fiscal year #bjbd4 7#b7 ,for purposes of carrying out the amendments made by subsection 7b71 there are appropriated to the ,department of ,labor1 out of amounts in the ,treasury not otherwise appropriated1 #dc1gej1jjj for fiscal year #bjbd4 7e7 ,,aspe ,study ,the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services shall conduct or commission a study on how the ,united ,states health care market would be impacted by potential regulatory changes disallowing manufacturer rebates in the manner and to the extent allowed on the date of enactment of this ,act1 with a focus on the impact to stakeholders in the commercial insurance market1 and1 not later than #a year after the date of enactment of this ,act1 submit a report to ,congress on the results of such study4 ,such study and report shall consider the following3 7#a7 ,the impact on the impact of making no such regulatory changes1 as well as potential behavioral changes by plan sponsors1 members1 and pharmaceutical manufacturers1 such as tighter formularies1 changes to price concessions1 changes in utilization1 if such regulatory changes are made4 7#b7 ,the mechanics needed in the pharmaceutical supply chain 7whether existing or not7 to move a manufacturer rebate to the point of sale4 7#c7 ,the feasibility of a partial point-of-sale manufacturer rebate versus a full point-of-sale manufacturer rebate4 7#d7 ,the impact on patient out-of-pocket costs1 premiums1 and other cost-sharing4 7#e7 ,possible behavioral changes by other third parties in the pharmaceutical supply chain including drug manufacturer1 distributor1 wholesaler1 rebate aggregators1 pharmacy services administrative organizations1 or group purchasing organizations4 7#f7 ,behavioral changes between entities that contract with pharmaceutical manufacturers and pharmaceutical supply chain4 7#g7 ,alternative price negotiation mechanisms1 including the impact of the ,act of ,june #ai1 #aicf 7commonly known as the ,robinson-,patman ,act2 #di ,stat4 #aebf1 chapter #eib2 #ae ,u4,s4,c4 #ac;a et seq471 and the amendments made by that ,act1 on drug pricing negotiations4 7#h7 ,the impact on pharmacies1 including pharmacy rebates1 pharmacy fees1 and dispensing channels4 7f7 ,,gao study 7#a7 ,in general ,not later than ,january #a1 #bjbi1 the ,comptroller ,general of the ,united ,states shall report to ,congress on-- 7,a7 pharmacy networks of group health plans1 health insurance issuers1 and entities providing pharmacy benefit management services under such group health plan or group or individual health insurance coverage1 including networks that have pharmacies that are under common ownership 7in whole or part7 with group health plans1 health insurance issuers1 or entities providing pharmacy benefit management services or pharmacy benefit administrative services under group health plan or group or individual health insurance coverage2 7,b7 as it relates to pharmacy networks that include pharmacies under common ownership described in subparagraph 7,a7-- 7i7 whether such networks are designed to encourage participants and beneficiaries of a plan or coverage to use such pharmacies over other network pharmacies for specific services or drugs1 and if so1 the reasons the networks give for encouraging use of such pharmacies2 and 7ii7 whether such pharmacies are used by participants and beneficiaries disproportionately more in the aggregate or for specific services or drugs compared to other network pharmacies2 7,c7 whether group health plans and health insurance issuers offering group or individual health insurance coverage have options to elect different network pricing arrangements in the marketplace with entities that provide pharmacy benefit management services1 the prevalence of electing such different network pricing arrangements2 7,d7 pharmacy network design parameters that encourage participants and beneficiaries in the plan or coverage to fill prescriptions at mail order1 specialty1 or retail pharmacies that are wholly or partially-owned by that issuer or entity2 and 7,e7 the degree to which mail order1 specialty1 or retail pharmacies that dispense prescription drugs to participants and beneficiaries in a group health plan or health insurance coverage that are under common ownership 7in whole or part7 with group health plans1 health insurance issuers1 or entities providing pharmacy benefit management services or pharmacy benefit administrative services under group health plan or group or individual health insurance coverage receive reimbursement that is greater than the median price charged to the group health plan or health insurance issuer when the same drug is dispensed to participants and beneficiaries in the plan or coverage by other pharmacies included in the pharmacy network of that plan1 issuer1 or entity that are not wholly or partially owned by the health insurance issuer or entity providing pharmacy benefit management services4 7#b7 ,requirement ,in carrying out paragraph 7#a71 the ,comptroller ,general of the ,united ,states shall not disclose-- 7,a7 information that would allow for identification of a specific individual1 plan sponsor1 health insurance issuer1 plan1 or entity providing pharmacy benefit management services2 or 7,b7 commercial or financial information that is privileged or confidential4 7#c7 ,definitions ,in this subsection1 the terms group health plan1 health insurance coverage1 and health insurance issuer have the meanings given such terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74