Title 42 — The Public Health and WelfareRelease 119-73

§300gg–120 Reporting on pharmacy benefits and drug costs

Title 42 › Chapter CHAPTER 6A— - PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER XXV— - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part Part D— - Additional Coverage Provisions › § 300gg–120

Last updated Apr 6, 2026|Official source

Summary

Health plans and health insurance companies (not church plans) must send a yearly report to the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury. The first report was due within 1 year after December 27, 2020, and after that reports are due by June 1 each year. The report must list the plan year dates, number of enrollees, the states where the plan is offered, the top 50 brand drugs by number of paid pharmacy claims, the top 50 drugs by total annual spending and how much was spent on each, the 50 drugs with the biggest rise in spending and the change in spending, total health care spending broken down by hospital, primary care, specialty care, prescription drugs, and other medical costs (including wellness), prescription drug spending split between the plan and enrollees, average monthly premiums paid by employers and by enrollees, how rebates/fees from drug makers affected premiums (amounts by drug class and for the 25 drugs with the largest rebates), and any reductions in premiums or out‑of‑pocket costs tied to those rebates. The Department of Health and Human Services must put a public report online about drug reimbursements, pricing trends, and how drug costs affect premiums. That public report must appear within 18 months after the first reports are due and then biannually after that. The public report will be summarized so no specific plan or drug data is revealed, and no confidential or trade‑secret information will be published.

Full Legal Text

Title 42, §300gg–120

The Public Health and Welfare — Source: USLM XML via OLRC

(a)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 issuer offering group or individual health insurance coverage (except for a church plan) shall submit to the Secretary, the Secretary of Labor, 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 enrollees.

(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 enrollees.

(8)The average monthly premium—

(A)paid by employers on behalf of enrollees, as applicable; and

(B)paid by enrollees.

(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 enrollees 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)Not later than 18 months after the date on which the first report is required under subsection (a) and biannually thereafter, the Secretary, acting through the Assistant Secretary of Planning and Evaluation and in coordination with the Inspector General of the Department of Health and Human Services, shall make available on the internet website of the Department of Health and Human Services a report on prescription drug reimbursements under group health plans and group and individual health insurance coverage, 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.

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

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–120

Title 42 — The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73