§1185n Reporting on Pharmacy Benefits and Drug Costs

Summary

Group health plans must send a report to the Labor Secretary, the Health and Human Services Secretary, and the Treasury Secretary within 1 year after December 27, 2020, and by June 1 each year after that. The report covers the prior plan year and must include: the plan year dates; number of people covered; the states where the plan is offered; the 50 drugs most often filled with claim counts; the 50 most expensive drugs by yearly spending with amounts; the 50 drugs with the biggest spending increases and the change in spending; total health care spending broken down by type (hospital; provider care split into primary and specialty; prescription drugs; other medical, including wellness); prescription drug spending split between the plan and enrollees; average monthly premiums paid by employers and by enrollees; how rebates, fees, or other payments from drug makers affected premiums, shown by drug class and for the 25 drugs with the largest such payments; and any reductions in premiums or out‑of‑pocket costs tied to those payments. No later than 18 months after the first set of reports are due, and then biannually afterward, the Labor Secretary, working with the Department of Labor’s Inspector General, must post an internet report on prescription drug reimbursements, pricing trends, and how drug costs affect premiums. The posted report must be rolled up so no plan or drug can be identified, and it cannot include any confidential or trade secret information that was submitted.