§9825 — Title 26 Internal Revenue Code | U.S. Code

Summary

Employer group health plans must report detailed prescription drug cost data to the federal government every year. The first report was due within 1 year after the Consolidated Appropriations Act, 2021 was enacted, and reports are due by June 1 each year after that, covering the previous plan year. Each plan must report its plan-year dates, number of participants, and the states where it operates, plus three top-50 drug lists: the 50 brand drugs most frequently dispensed, the 50 most costly drugs by total spending, and the 50 drugs with the biggest year-over-year increase in plan spending. Plans must also break down total health care spending — hospital, primary and specialty care, prescription drugs, and other medical costs — report average monthly premiums paid by employers and by participants, and disclose how rebates and fees from drug manufacturers affect premiums, including the 25 drugs that produced the highest rebates. Using this data, the Treasury Department must publish a public report on drug pricing trends every two years, starting 18 months after the first plan reports, with everything aggregated so no plan or drug-specific confidential information is revealed.

Title 26, §9825

Internal Revenue Code — Source: USLM XML via OLRC

(a)Not later than 1 year after the date of enactment of the Consolidated Appropriations Act, 2021, and not later than June 1 of each year thereafter, a group health plan shall submit to the Secretary, the Secretary of Health and Human Services, and the Secretary of Labor the following information with respect to the health plan in the previous plan year:

(1)The beginning and end dates of the plan year.

(2)The number of participants and beneficiaries.

(3)Each State in which the plan is offered.

(4)The 50 brand prescription drugs most frequently dispensed by pharmacies for claims paid by the plan, and the total number of paid claims for each such drug.

(5)The 50 most costly prescription drugs with respect to the plan by total annual spending, and the annual amount spent by the plan 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 in each such plan year.

(7)Total spending on health care services by such group health plan, 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; and

(ii)the participants and beneficiaries.

(8)The average monthly premium—

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

(B)paid by participants and beneficiaries.

(9)Any impact on premiums by rebates, fees, and any other remuneration paid by drug manufacturers to the plan or its administrators or service providers, with respect to prescription drugs prescribed to participants or beneficiaries in the plan, 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 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 in coordination with the Inspector General of the Department of the Treasury, shall make available on the internet website of the Department of the Treasury a report on prescription drug reimbursements under group health plans, prescription drug pricing trends, and the role of prescription drug costs in contributing to premium increases or decreases under such plans, 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).

Editorial Notes

References in Text

The date of enactment of the Consolidated Appropriations Act, 2021, referred to in subsec. (a), is the date of enactment of Pub. L. 116–260, which was approved Dec. 27, 2020.

§9825 Reporting on Pharmacy Benefits and Drug Costs

Summary

Title 26, §9825

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata