Title 42, The Public Health and WelfareRelease 119-102
§300gg–19b Information on Prescription Drugs
Title 42 › CHAPTER 6A — PUBLIC HEALTH SERVICE › SUBCHAPTER XXV — REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part A — Individual and Group Market Reforms › Subpart II — Improving Coverage › § 300gg–19b
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Title 42, §300gg–19b
The Public Health and Welfare, Source: USLM XML via OLRC
(a)A group health plan or a health insurance issuer offering group or individual health insurance coverage shall—
(1)not restrict, directly or indirectly, any pharmacy that dispenses a prescription drug to an enrollee in the plan or coverage from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee’s out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage; and
(2)ensure that any entity that provides pharmacy benefits management services under a contract with any such health plan or health insurance coverage does not, with respect to such plan or coverage, restrict, directly or indirectly, a pharmacy that dispenses a prescription drug from informing (or penalize such pharmacy for informing) an enrollee of any differential between the enrollee’s out-of-pocket cost under the plan or coverage with respect to acquisition of the drug and the amount an individual would pay for acquisition of the drug without using any health plan or health insurance coverage.
(b)For purposes of this section, the term “out-of-pocket cost”, with respect to acquisition of a drug, means the amount to be paid by the enrollee under the plan or coverage, including any cost-sharing (including any deductible, copayment, or coinsurance) and, as determined by the Secretary, any other expenditure.
Reference
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Citation
42 U.S.C. § 300gg–19b
Title 42, The Public Health and Welfare
Last Updated
Aug 21, 2026
Release point: 119-102