Title 42, The Public Health and WelfareRelease 119-110

§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

Last updated Sep 22, 2026|Official source

Summary

Requires group health plans and insurers to let pharmacies tell patients when the price they would pay using the plan is different from the price if they bought the drug without insurance. Plans and insurers must not block or punish pharmacies for giving that information, and any pharmacy benefit manager working for the plan must follow the same rule. Out-of-pocket cost — the amount the patient must pay under the plan, including deductible, copayment, coinsurance, and any other expense the Secretary defines.

Full Legal Text

Title 42, §300gg–19b

The Public Health and Welfare, Source: USLM XML via OLRC

(a)In general

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)Definition

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

Citations & Metadata

Citation

42 U.S.C. § 300gg–19b

Title 42, The Public Health and Welfare

Last Updated

Sep 22, 2026

Release point: 119-110