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Health Plan Transparency: Mandatory Disclosure of Hidden Fees by PBMs and TPAs.

This Act mandates comprehensive disclosure of all fees, rebates, and compensation received by Pharmacy Benefit Managers (PBMs) and Third Party Administrators (TPAs) operating within employer-sponsored health plans. The goal is to eliminate hidden costs, allowing plan sponsors (employers) to negotiate better contracts. This increased transparency could ultimately lead to lower prescription drug costs and administrative fees for employees, effective January 1, 2025.
Key points
PBMs must disclose all compensation, including rebates and discounts from drug manufacturers, and specify how much of that money is passed back to the health plan or participants.
The law requires transparency regarding "clawbacks"—money retained by PBMs when a patient's co-payment exceeds the actual cost of the drug.
Third Party Administrators (TPAs) must disclose all fees and recovered amounts (e.g., from overpayments or subrogation) that they retain as compensation, increasing clarity on administrative costs.
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Additional Information
Print number: 118_HR_4508
Sponsor: Rep. Courtney, Joe [D-CT-2]
Process start date: 2023-07-10
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Summarized by: gemini-flash-latest
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

Hidden Fee Disclosure Act of 2023

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 118_HR_4508.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

When did the legislative process begin?

The process officially started on 2023-07-10.

What are the main provisions?

Key points include:

  • PBMs must disclose all compensation, including rebates and discounts from drug manufacturers, and specify how much of that money is passed back to the health plan or participants.
  • The law requires transparency regarding "clawbacks"—money retained by PBMs when a patient's co-payment exceeds the actual cost of the drug.
  • Third Party Administrators (TPAs) must disclose all fees and recovered amounts (e.g., from overpayments or subrogation) that they retain as compensation, increasing clarity on administrative costs.
What is the specific legal status?

The current status is Expired.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Rep. Courtney, Joe [D-CT-2].

What is the latest detailed status?

The latest detailed status is: Placed on the Union Calendar, Calendar No. 209.

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-30.

CATEGORIES

Health Labor