Title 42 — The Public Health and WelfareRelease 119-73

§300gg–19b Information on prescription drugs

Title 42 › Chapter CHAPTER 6A— - PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER XXV— - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part Part A— - Individual and Group Market Reforms › Subpart Subpart II— - Improving Coverage › § 300gg–19b

Last updated Apr 6, 2026|Official source

Summary

Group health plans and insurers must let pharmacies tell people covered by the plan when a prescription would cost less if paid for without using the insurance. Plans cannot stop or punish a pharmacy for giving that price difference. Plans must also make sure any company that manages pharmacy benefits for them follows the same rule. Out-of-pocket cost: the amount the person pays under the plan, including any deductible, copayment, or coinsurance, and any other expense the Secretary decides.

Full Legal Text

Title 42, §300gg–19b

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

(a)A group health plan or a health insurance issuer offering group or individual health insurance coverage shall—

(1)not restrict, directly or indirectly, any pharmacy that dispenses a prescription drug to an enrollee in the plan or coverage from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee’s out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage; and

(2)ensure that any entity that provides pharmacy benefits management services under a contract with any such health plan or health insurance coverage does not, with respect to such plan or coverage, restrict, directly or indirectly, a pharmacy that dispenses a prescription drug from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee’s out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage.

(b)For purposes of this section, the term “out-of-pocket cost”, with respect to acquisition of a drug, means the amount to be paid by the enrollee under the plan or coverage, including any cost-sharing (including any deductible, copayment, or coinsurance) and, as determined by the Secretary, any other expenditure.

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–19b

Title 42 — The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73