29 U.S.C. § 1185n — Reporting on pharmacy benefits and drug costs

submitted 6 years ago by Pub. L. 93-406 to r/title-29-LABOR · 549 words · no verdicts yet

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Each group health plan or related issuer must annually report specified plan, participant, state, drug, spending, premium, and rebate information. The Secretary must publish an aggregated report about drug reimbursements, pricing trends, and drug costs without making drug-specific, plan-specific, confidential, or trade-secret information public.

(a) In general. By one year after December 27, 2020, and by June 1 each later year, a plan or related issuer must send the Secretary and the Secretaries of Health and Human Services and the Treasury for the previous plan year: (1) plan-year start and end; (2) participants and beneficiaries; (3) states where offered; (4) the 50 most frequently dispensed brand drugs and paid claims for each; (5) the 50 costliest drugs and annual spending for each; (6) the 50 drugs with the greatest spending increase and the change for each year; (7) total health-service spending, broken down by (A) hospital, primary-care, specialty-care, prescription-drug, and other medical costs including wellness, and (B) drug spending by the plan and by participants and beneficiaries; (8) average monthly premium paid by employers and by participants and beneficiaries; (9) premium effects of manufacturer rebates, fees, and other payments, including (A) amounts by therapeutic class and (B) amounts for the 25 drugs producing the most; and (10) premium and out-of-pocket reductions tied to those payments. (b) Report. Within 18 months after the first report, and every two years thereafter, the Secretary, with the Labor Department Inspector General, must post a report on the Labor Department website about drug reimbursements, pricing trends, and drug costs’ role in premium increases or decreases. It must be aggregated so no drug- or plan-specific information is public. (c) Privacy. No confidential or trade-secret information submitted under (a) may be included.

the actual law source: uscode.house.gov ↗public domain

(a) In general

Not later than 1 year after December 27, 2020, and not later than June 1 of each year thereafter, a group health plan (or health insurance coverage offered in connection with such a plan) shall submit to the Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury the following information with respect to the health plan or coverage in the previous plan year:

(1)

The beginning and end dates of the plan year.

(2)

The number of participants and beneficiaries.

(3)

Each State in which the plan or coverage is offered.

(4)

The 50 brand prescription drugs most frequently dispensed by pharmacies for claims paid by the plan or coverage, and the total number of paid claims for each such drug.

(5)

The 50 most costly prescription drugs with respect to the plan or coverage by total annual spending, and the annual amount spent by the plan or coverage for each such drug.

(6)

The 50 prescription drugs with the greatest increase in plan expenditures over the plan year preceding the plan year that is the subject of the report, and, for each such drug, the change in amounts expended by the plan or coverage in each such plan year.

(7)

Total spending on health care services by such group health plan or health insurance coverage, broken down by—

(A)

the type of costs, including—

(i)

hospital costs;

(ii)

health care provider and clinical service costs, for primary care and specialty care separately;

(iii)

costs for prescription drugs; and

(iv)

other medical costs, including wellness services; and

(B)

spending on prescription drugs by—

(i)

the health plan or coverage; and

(ii)

the participants and beneficiaries.

(8)

The average monthly premium—

(A)

paid by employers on behalf of participants and beneficiaries, as applicable; and

(B)

paid by participants and beneficiaries.

(9)

Any impact on premiums by rebates, fees, and any other remuneration paid by drug manufacturers to the plan or coverage or its administrators or service providers, with respect to prescription drugs prescribed to participants or beneficiaries in the plan or coverage, including—

(A)

the amounts so paid for each therapeutic class of drugs; and

(B)

the amounts so paid for each of the 25 drugs that yielded the highest amount of rebates and other remuneration under the plan or coverage from drug manufacturers during the plan year.

(10)

Any reduction in premiums and out-of-pocket costs associated with rebates, fees, or other remuneration described in paragraph (9).

(b) Report

Not later than 18 months after the date on which the first report is required under subsection (a) and biannually thereafter, the Secretary, acting in coordination with the Inspector General of the Department of Labor, shall make available on the internet website of the Department of Labor a report on prescription drug reimbursements under group health plans (or health insurance coverage offered in connection with such a plan), prescription drug pricing trends, and the role of prescription drug costs in contributing to premium increases or decreases under such plans or coverage, aggregated in such a way as no drug or plan specific information will be made public.

No confidential or trade secret information submitted to the Secretary under subsection (a) shall be included in the report under subsection (b).

Source credit: (Pub. L. 93–406, title I, § 725, as added Pub. L. 116–260, div. BB, title II, § 204(b), Dec. 27, 2020, 134 Stat. 2919.)

history & why it existsrecord from the source credit

2020Enacted · Pub. L. 93-406 · 134 Stat. 2919

A history note hasn’t been published yet. The record shows enactment by Pub. L. 93-406 on 2020-12-27.

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