29 U.S.C. § 1185n Reporting On Pharmacy Benefits and Drug Costs

• Library: United States Statutes
• Edition: 2023
• Currency: Current through P.L. 118-22 with Court Rules updates (published on www.congress.gov on 12/01/2023)
• Year: 2023
• Citation: 29 U.S.C. § 1185n

(a) In general

Not later than 1 year after December 27, 2020, and not later than June 1 of each year thereafter, a group health plan (or health insurance coverage offered in connection with such a plan) shall submit to the Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury the following information with respect to the health plan or coverage in the previous plan year:

(1) The beginning and end dates of the plan year.

(2) The number of participants and beneficiaries.

(3) Each State in which the plan or coverage is offered.

(4) The 50 brand prescription drugs most frequently dispensed by pharmacies for claims paid by the plan or coverage, and the total number of paid claims for each such drug.

(5) The 50 most costly prescription drugs with respect to the plan or coverage by total annual spending, and the annual amount spent by the plan or coverage for each such drug.

(6) The 50 prescription drugs with the greatest increase in plan expenditures over the plan year preceding the plan year that is the subject of the report, and, for each such drug, the change in amounts expended by the plan or coverage in each such plan year.

(7) Total spending on health care services by such group health plan or health insurance coverage, broken down by-

(A) the type of costs, including-

(i) hospital costs;

(ii) health care provider and clinical service costs, for primary care and specialty care separately;

(iii) costs for prescription drugs; and

(iv) other medical costs, including wellness services; and

(B) spending on prescription drugs by-

(i) the health plan or coverage; and

(ii) the participants and beneficiaries.

(8) The average monthly premium-

(A) paid by employers on behalf of participants and beneficiaries, as applicable; and