§9825 Reporting on pharmacy benefits and drug costs

Summary

Group health plans must send a yearly report to the Treasury Secretary, the Health and Human Services Secretary, and the Labor Secretary. The first report is due within 1 year after the Consolidated Appropriations Act, 2021 became law, and then each year by June 1. The report covers the prior plan year. It must list plan start and end dates, how many people are covered, the states where the plan is offered, the 50 drugs most often dispensed (with claim counts), the 50 drugs with the highest total spending (with amounts), the 50 drugs with the largest spending increases (with the change), total health spending broken into hospital, primary and specialty care, prescription drugs, and other medical costs, drug spending split between the plan and participants, average monthly premiums paid by employers and by participants, how rebates and other payments from drug makers affected premiums (by drug class and for the 25 drugs with the largest payments), and any premium or out-of-pocket reductions from those payments. Eighteen months after the first report, and biannually thereafter, the Treasury must publish an aggregated public report online about drug reimbursements, pricing trends, and how drug costs affect premiums. That public report may not include trade secrets or any confidential information that would identify a specific drug or plan.