§9825 Reporting on Pharmacy Benefits and Drug Costs

Summary

Group health plans must send a yearly report to the Secretary of the Treasury, the Secretary of Health and Human Services, and the Secretary of Labor. The first report is due within 1 year after the Consolidated Appropriations Act, 2021 became law, and then by June 1 each year for the previous plan year. The report must include the plan year dates, number of people covered, the States where the plan is offered, the 50 most dispensed drugs with claim counts, the 50 most costly drugs with amounts spent, the 50 drugs with the biggest increase in spending and the change amounts, total health care spending broken down by type (for example hospitals, primary and specialty care, drugs, and other medical services), how much was spent on drugs by the plan versus by participants, average monthly premiums paid by employers and by participants, amounts paid to the plan or its vendors by drug makers (by drug class and for the top 25 drugs by rebates), and any premium or out-of-pocket reductions tied to those payments. Within 18 months after the first reports are due, and every two years after that, the Secretary (working with the Treasury Inspector General) must publish a web report about drug reimbursements, price trends, and how drug costs affect premiums. The public report must be aggregated so no drug- or plan-specific data is made public, and confidential or trade-secret information given to the Secretary must not be included.