Section 1150A Social Security Act

PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS
SEC. 1150A. [42 U.S.C. 1320b–23] (a) PROVISION OF INFORMATION.—A health benefits plan
or any entity that provides pharmacy benefits management services on behalf of a
health benefits plan (in this section referred to as a “PBM”) that manages prescription
drug coverage under a contract with—
(1) a PDP sponsor of a prescription drug plan or an MA organization offering an
MA–PD plan under part D of title XVIII; or
(2) a qualified health benefits plan offered through an exchange established by a
State under section 1311 of the Patient Protection and Affordable Care Act, shall
provide the information described in subsection (b) to the Secretary and, in the case
of a PBM, to the plan with which the PBM is under contract with, at such times, and
in such form and manner, as the Secretary shall specify.
(b) INFORMATION DESCRIBED.—The information described in this subsection is the
following with respect to services provided by a health benefits plan or PBM for a
contract year:
(1) The percentage of all prescriptions that were provided through retail
pharmacies compared to mail order pharmacies, and the percentage of
prescriptions for which a generic drug was available and dispensed (generic
dispensing rate), by pharmacy type (which includes an independent pharmacy,
chain pharmacy, supermarket pharmacy, or mass merchandiser pharmacy that is
licensed as a pharmacy by the State and that dispenses medication to the general
public), that is paid by the health benefits plan or PBM under the contract.
(2) The aggregate amount, and the type of rebates, discounts, or price
concessions (excluding bona fide service fees, which include but are not limited to
distribution service fees, inventory management fees, product stocking allowances,
and fees associated with administrative services agreements and patient care
programs (such as medication compliance programs and patient education
programs)) that the PBM negotiates that are attributable to patient utilization under
the plan, and the aggregate amount of the rebates, discounts, or price concessions
that are passed through to the plan sponsor, and the total number of prescriptions
that were dispensed.
(3) The aggregate amount of the difference between the amount the health
benefits plan pays the PBM and the amount that the PBM pays retail pharmacies,
and mail order pharmacies, and the total number of prescriptions that were
dispensed.
(c) CONFIDENTIALITY.—Information disclosed by a health benefits plan or PBM under this
section is confidential and shall not be disclosed by the Secretary or by a plan receiving
the information, except that the Secretary may disclose the information in a form which

does not disclose the identity of a specific PBM, plan, or prices charged for drugs, for
the following purposes:
(1) As the Secretary determines to be necessary to carry out this section or part D
of title XVIII.
(2) To permit the Comptroller General to review the information provided.
(3) To permit the Director of the Congressional Budget Office to review the
information provided.
(4) To States to carry out section 1311 of the Patient Protection and Affordable
Care Act.
(d) PENALTIES.—The provisions of subsection (b)(3)(C) of section 1927 shall apply to a
health benefits plan or PBM that fails to provide information required under subsection
(a) on a timely basis or that knowingly provides false information in the same manner as
such provisions apply to a manufacturer with an agreement under that section.