§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 each year by June 1. The report covers the prior plan year and must include: plan year start and end dates; number of participants and beneficiaries; the states where the plan is offered; the top 50 brand drugs by pharmacy claims and how many claims for each; the 50 drugs that cost the most to the plan and the amount spent on each; the 50 drugs with the biggest increase in plan spending compared with the prior year and the change amounts; total health care spending broken into major types (hospital, provider—separating primary and specialty—prescription drugs, and other medical costs including wellness) and prescription drug spending split between the plan and participants; average monthly premiums paid by employers and by participants; amounts paid by drug manufacturers to the plan or its vendors (rebates, fees, or other payments) by therapeutic class and for the 25 drugs that generated the largest such payments; and any reductions in premiums or out-of-pocket costs tied to those payments. Eighteen months after the first required report, and every two years after that, the Treasury (working with the Treasury Inspector General) must publish a public, aggregated report on prescription drug reimbursements, price trends, and how drug costs affect premiums. The public report must be aggregated so it does not show any drug- or plan-specific details. No confidential or trade-secret information submitted by plans can be included in the public report.