I.R.C. § 9825(a) In General —
Not later than 1 year after the date of enactment of the Consolidated Appropriations
Act, 2021, and not later than June 1 of each year thereafter, a group health plan
shall submit to the Secretary, the Secretary of Health and Human Services, and the
Secretary of Labor the following information with respect to the health plan in the
previous plan year:
I.R.C. § 9825(a)(1) —
The beginning and end dates of the plan year.
I.R.C. § 9825(a)(2) —
The number of participants and beneficiaries.
I.R.C. § 9825(a)(3) —
Each State in which the plan is offered.
I.R.C. § 9825(a)(4) —
The 50 brand prescription drugs most frequently dispensed by pharmacies for claims
paid by the plan, and the total number of paid claims for each such drug.
I.R.C. § 9825(a)(5) —
The 50 most costly prescription drugs with respect to the plan by total annual spending,
and the annual amount spent by the plan for each such drug.
I.R.C. § 9825(a)(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 in each such plan year.
I.R.C. § 9825(a)(7) —
Total spending on health care services by such group health plan, broken down by—
I.R.C. § 9825(a)(7)(A) —
the type of costs, including—
I.R.C. § 9825(a)(7)(A)(i) —
hospital costs;
I.R.C. § 9825(a)(7)(A)(ii) —
health care provider and clinical service costs, for primary care and specialty care
separately;
I.R.C. § 9825(a)(7)(A)(iii) —
costs for prescription drugs; and
I.R.C. § 9825(a)(7)(A)(iv) —
other medical costs, including wellness services; and
I.R.C. § 9825(a)(7)(B) —
spending on prescription drugs by—
I.R.C. § 9825(a)(7)(B)(i) —
the health plan; and
I.R.C. § 9825(a)(7)(B)(ii) —
the participants and beneficiaries.
I.R.C. § 9825(a)(8) —
The average monthly premium—
I.R.C. § 9825(a)(8)(A) —
paid by employers on behalf of participants and beneficiaries, as applicable; and
I.R.C. § 9825(a)(8)(B) —
paid by participants and beneficiaries.
I.R.C. § 9825(a)(9) —
Any impact on premiums by rebates, fees, and any other remuneration paid by drug manufacturers
to the plan or its administrators or service providers, with respect to prescription
drugs prescribed to participants or beneficiaries in the plan, including—
I.R.C. § 9825(a)(9)(A) —
the amounts so paid for each therapeutic class of drugs; and
I.R.C. § 9825(a)(9)(B) —
the amounts so paid for each of the 25 drugs that yielded the highest amount of rebates
and other remuneration under the plan from drug manufacturers during the plan year.
I.R.C. § 9825(a)(10) —
Any reduction in premiums and out-of-pocket costs associated with rebates, fees, or
other remuneration described in paragraph (9).
I.R.C. § 9825(b) Report —
Not later than 18 months after the date on which the first report is required under
subsection (a) and biannually thereafter, the Secretary, acting in coordination with
the Inspector General of the Department of the Treasury, shall make available on the
internet website of the Department of the Treasury a report on prescription drug reimbursements
under group health plans, prescription drug pricing trends, and the role of prescription
drug costs in contributing to premium increases or decreases under such plans, aggregated
in such a way as no drug or plan specific information will be made public.
I.R.C. § 9825(c) Privacy Protections —
No confidential or trade secret information submitted to the Secretary under subsection
(a) shall be included in the report under subsection (b).
(Added by Pub. L. 116-260, Div. BB, title II, Sec. 204(c), Dec. 27, 2020, 134 Stat. 1182.)
BACKGROUND NOTES
EFFECTIVE DATE
Effective on December 27, 2020.
