Health plans would get more information about drug spending

Federal funds would pay for cost-sharing reductions in qualified health plans. The payments are for cost-sharing reductions under qualified health plans. The funds could not pay for a plan whose coverage includes abortion, unless abortion coverage is only for cases needed to save the mother's life or when pregnancy resulted from rape or incest. The funding applies to plan years beginning on or after January 1, 2027.

Pharmacy benefit managers would send drug spending reports to group health plans. The rules cover group health plans, insurers offering group coverage, pharmacy benefit managers, and certain related entities. Reports would cover drug prices, rebates, fees, and other spending details, with privacy protections. All covered group health plans would receive summary information, and members could request a summary and information about their own claims. Detailed drug-by-drug reports would be required for qualifying large self-insured plans. Qualifying large insured plans could elect to require those reports in addition to the summaries. The rules apply to plan years beginning 30 months after enactment and to contracts entered into, renewed, or extended on or after that date. Reports are due at least every six months; a plan may request quarterly reports.

Employers could join an association to offer a group health plan. Employers from different industries, trades, or professions could join, along with eligible self-employed people. The association must have existed for at least two years and been formed for reasons beyond offering health coverage. It must make coverage available to at least 51 employees and to all employees of member employers and their dependents. Employer members must control the association and plan. The plan could not discriminate based on health status or deny coverage for a pre-existing condition. Self-employed participants must meet eligibility checks. The association must have existed for at least two years before offering a plan.

Employers could offer certain fixed-dollar health reimbursement arrangements to employee groups. The rules cover employer-funded health reimbursement arrangements offered to employees in permitted classes. The arrangement must use only employer contributions, set a fixed maximum, and reimburse care only while a person has qualifying individual or Medicare coverage. It must offer the same terms to employees in a permitted class, check proof of coverage, and give notice. An employee in a qualifying arrangement could use a cafeteria plan to buy exchange insurance. Employers would also report the arrangement's permitted benefits on tax forms. The arrangement rules apply to plan years beginning after December 31, 2025. Benefit reporting applies to tax years beginning after that date.