§1185n Reporting on Pharmacy Benefits and Drug Costs

Summary

Group health plans and the health insurance sold with them must send a yearly report to the Labor Department, the Department of Health and Human Services, and the Treasury. The first report was due not later than 1 year after December 27, 2020, and then by June 1 each year. The report covers the prior plan year and must say the plan year dates; how many people were covered; which States the plan was offered in; the 50 most-used brand drugs and their claim counts; the 50 drugs with the highest total spending and amounts spent; the 50 drugs with the biggest spending increase and the change amounts; total health care spending broken down by major cost types (like hospital, provider care split into primary and specialty, drugs, and other medical services) and who paid drug costs (plan vs. people); average monthly premiums paid by employers and by participants; how much drug makers paid back to the plan or its managers (by drug class and the top 25 drugs by such payments); and any premium or out-of-pocket reductions tied to those payments. Not later than 18 months after the first report, and biannually after that, the Labor Department, working with its Inspector General, must post an online summary about drug reimbursements, pricing trends, and how drug costs affect premiums. That public summary must be aggregated so it does not reveal any confidential, trade-secret, drug-specific, or plan-specific information.