I
119THCONGRESS
1
STSESSION H. R. 2041
To amend the Employee Retirement Income Security Act of 1974 to clarify
and strengthen the application of certain employer-sponsored health plan
disclosure requirements.
IN THE HOUSE OF REPRESENTATIVES
MARCH11, 2025
Mr. C
OURTNEY(for himself and Mrs. HOUCHIN) introduced the following bill;
which was referred to the Committee on Education and Workforce
A BILL
To amend the Employee Retirement Income Security Act
of 1974 to clarify and strengthen the application of
certain employer-sponsored health plan disclosure re-
quirements.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Hidden Fee Disclosure 4
Act of 2025’’. 5
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SEC. 2. CLARIFICATION OF THE APPLICATION OF FEE DIS-1
CLOSURE REQUIREMENTS TO COVERED 2
SERVICE PROVIDERS. 3
(a) S
ERVICES.—Clause (ii)(I)(bb) of section 4
408(b)(2)(B) of the Employee Retirement Income Secu-5
rity Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is amended— 6
(1) in subitem (AA) by striking ‘‘Brokerage 7
services,’’ and inserting ‘‘Services (including broker-8
age services),’’; and 9
(2) in subitem (BB)— 10
(A) by striking ‘‘Consulting,’’ and inserting 11
‘‘Other services,’’; and 12
(B) by striking ‘‘related to the development 13
or implementation of plan design’’ and all that 14
follows through the period at the end and in-15
serting ‘‘any of the following: plan design, claim 16
repricing, insurance or insurance product selec-17
tion (including vision and dental), record-18
keeping, medical management, benefits adminis-19
tration selection (including vision and dental), 20
stop-loss insurance, pharmacy benefit manage-21
ment services, wellness design and management 22
services, transparency tools, group purchasing 23
organization agreements and services, participa-24
tion in and services from preferred vendor pan-25
els, disease management, compliance services, 26
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employee assistance programs, or third party 1
administration services, or consulting services 2
related to any such services.’’. 3
(b) D
ISCLOSURES.—Clause (iii)(III) of section 4
408(b)(2)(B) of the Employee Retirement Income Secu-5
rity Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is amended 6
by striking ‘‘, either in the aggregate or by service,’’ and 7
inserting ‘‘by service’’. 8
SEC. 3. STRENGTHENING DISCLOSURE REQUIREMENTS 9
WITH RESPECT TO ENTITIES PROVIDING 10
PHARMACY BENEFIT MANAGEMENT SERV-11
ICES AND THIRD PARTY ADMINISTRATORS 12
FOR GROUP HEALTH PLANS. 13
(a) C
ERTAINARRANGEMENTS FOR PHARMACYBEN-14
EFITMANAGEMENT SERVICESCONSIDERED AS INDI-15
RECT.— 16
(1) I
N GENERAL.—Clause (i) of section 17
408(b)(2)(B) of the Employee Retirement Income 18
Security Act of 1974 (29 U.S.C. 1108(b)(2)(B)) is 19
amended— 20
(A) by striking ‘‘requirements of this 21
clause’’ and inserting ‘‘requirements of this 22
subparagraph’’; and 23
(B) by adding at the end the following: 24
‘‘For purposes of applying section 406(a)(1)(C) 25
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with respect to a transaction described under 1
this subparagraph, a contract or arrangement 2
for services between a covered plan and an enti-3
ty or subsidiary providing services to the plan, 4
including a health insurance issuer providing 5
health insurance coverage in connection with 6
the covered plan in which the entity or sub-7
sidiary contracts, in connection with such plan, 8
with a service provider for pharmacy benefit 9
management services shall be considered an in-10
direct furnishing of goods, services, or facilities 11
between the covered plan and the service pro-12
vider for pharmacy benefit management services 13
acting as the party in interest.’’. 14
(2) H
EALTH INSURANCE ISSUER AND HEALTH 15
INSURANCE COVERAGE DEFINED .—Clause (ii)(I)(aa) 16
of section 408(b)(2)(B) of the Employee Retirement 17
Income Security Act of 1974 (29 U.S.C. 18
1108(b)(2)(B)) is amended by inserting before the 19
period at the end ‘‘and the terms ‘health insurance 20
coverage’ and ‘health insurance issuer’ have the 21
meanings given such terms in section 733(b)’’. 22
(3) T
ECHNICAL AMENDMENT .—Section 23
408(b)(2)(B)(ii)(I)(aa) of the Employee Retirement 24
Income Security Act of 1974 (29 U.S.C. 25
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1108(b)(2)(B)(ii)(I)(aa)) is further amended by in-1
serting ‘‘in’’ after ‘‘defined’’. 2
(b) S
PECIFICDISCLOSUREREQUIREMENTS WITH 3
R
ESPECT TOENTITIESPROVIDINGPHARMACYBENEFIT 4
M
ANAGEMENTSERVICES.— 5
(1) I
N GENERAL.—Clause (iii) of section 6
408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) 7
is amended by adding at the end the following: 8
‘‘(VII) In the case of a covered service pro-9
vider in a contract or arrangement with a cov-10
ered plan to provide pharmacy benefit manage-11
ment services, as part of the description re-12
quired under subclauses (III) and (IV)— 13
‘‘(aa) all compensation described in 14
clause (ii)(I)(dd)(AA), including fees, re-15
bates, alternative discounts, price conces-16
sions, co-payment offsets, and other remu-17
neration reasonably expected to be received 18
by the covered service provider, an affil-19
iate, or a subcontractor from a drug manu-20
facturer, distributor, rebate aggregator, ac-21
cumulator, maximizer, group purchasing 22
organization, or any other third party; 23
‘‘(bb) the amount and form of any 24
fees, rebates, alternative discounts, price 25
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concessions, co-payment offsets, and other 1
remuneration, including the amount ex-2
pected to be passed through to the plan 3
sponsor or the participants and bene-4
ficiaries under the covered plan; 5
‘‘(cc) all compensation reasonably ex-6
pected to be received by the covered service 7
provider, an affiliate, or a subcontractor as 8
a result of paying a lower amount for the 9
drug than the amount charged as a copay-10
ment, coinsurance amount, or deductible; 11
‘‘(dd) all compensation expected to be 12
received by the covered service provider, an 13
affiliate, or a subcontractor as a result of 14
paying pharmacies less than the amount 15
charged to the health plan, plan sponsor, 16
or participants and beneficiaries (com-17
monly referred to as ‘spread pricing’); 18
‘‘(ee) all compensation expected to be 19
received by the covered service provider, an 20
affiliate, or a subcontractor from drug 21
manufacturers or any other third party in 22
exchange for— 23
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‘‘(AA) administering, invoicing, 1
allocating, or collecting rebates related 2
to the covered plan; 3
‘‘(BB) providing access to drug 4
utilization data; 5
‘‘(CC) retaining a percentage of 6
the list price of a drug; or 7
‘‘(DD) any other service related 8
to the role of the covered service pro-9
vider as a conduit between the drug 10
manufacturers or any other third 11
party and the covered plan.’’. 12
(2) A
NNUAL DISCLOSURE .—Clause (v) of sec-13
tion 408(b)(2)(B) of such Act (29 U.S.C. 14
1108(b)(2)(B)) is amended by adding at the end the 15
following: 16
‘‘(III) A covered service provider, with respect 17
to a contract or arrangement with the covered plan 18
in connection with providing pharmacy benefit man-19
agement services, shall disclose, on an annual basis 20
not later than 60 days after the beginning of each 21
plan year, to a responsible plan fiduciary, in writing, 22
the following with respect to the preceding plan 23
year: 24
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‘‘(aa) All direct compensation described in 1
subclause (III) of clause (iii) and indirect com-2
pensation described in subclause (IV) of clause 3
(iii) received by the covered service provider (in-4
cluding such compensation described in sub-5
clause (VII) of clause (iii)). 6
‘‘(bb) The total gross spending by the cov-7
ered plan on drugs (excluding fees rebates, al-8
ternative discounts, price concessions, co-pay-9
ment offsets, and other remuneration). 10
‘‘(cc) The total net spending by the cov-11
ered plan on drugs. 12
‘‘(dd) The total gross spending on drugs at 13
all pharmacies wholly or partially owned by the 14
covered service provider or any entity affiliated 15
with the covered service provider, including 16
mail-order, specialty and retail pharmacies, with 17
a breakdown by individual pharmacy location. 18
‘‘(ee) The aggregate amount of cost-shar-19
ing collected by the covered service provider 20
from a pharmacy for a participant or bene-21
ficiary in excess of the contracted rate from 22
such pharmacies, including mail-order, spe-23
cialty, and retail pharmacies, including— 24
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‘‘(AA) categorical explanations 1
(grouped by the reason for collection of 2
such amounts, such as contractual true-up 3
provisions, overpayments, or non-covered 4
medication dispensed, and including infor-5
mation on the amount in each category 6
that was passed through to the covered 7
plan and to participants and beneficiaries 8
of the covered plan); or 9
‘‘(BB) individual explanations for 10
such amounts. 11
‘‘(ff) Total aggregate amounts of fees col-12
lected by the covered service provider, an affil-13
iate, or a subcontractor in connection with the 14
provision of pharmacy benefit management 15
services to the covered plan, broken down by 16
the source of such fees (such as the covered 17
plan, participants and beneficiaries of the cov-18
ered plan, any drug manufacturer or whole-19
saler, or any pharmacy entity). 20
‘‘(gg) Any information specified by the 21
Secretary through regulations or guidance that 22
may be necessary for a responsible plan fidu-23
ciary to determine the reasonableness of the 24
contract or arrangement with the covered serv-25
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ice provider, any compensation paid under such 1
a contract or arrangement, or any conflicts of 2
interest that may exist.’’. 3
(3) P
HARMACY BENEFIT MANAGEMENT SERV -4
ICES DEFINED .—Clause (ii)(I) of section 5
408(b)(2)(B) of such Act (29 U.S.C. 1108(b)(2)(B)) 6
is amended by adding at the end the following: 7
‘‘(gg) The term ‘pharmacy benefit manage-8
ment services’ includes any services provided by 9
a covered service provider to a covered plan 10
with respect to the administration of prescrip-11
tion drug benefits under the covered plan, in-12
cluding— 13
‘‘(AA) the processing and payment of 14
claims; 15
‘‘(BB) design of pharmacy networks; 16
‘‘(CC) negotiation, aggregation, and 17
distribution of rebates, discounts, and 18
other price concessions; 19
‘‘(DD) formulary design and mainte-20
nance; 21
‘‘(EE) operation of pharmacies 22
(whether retail, mail order, specialty drug, 23
or otherwise); recordkeeping; 24
‘‘(FF) utilization review; 25
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‘‘(GG) adjudication of claims; and 1
‘‘(HH) any other services specified by 2
the Secretary through guidance or rule-3
making.’’. 4
(c) S
PECIFICDISCLOSUREREQUIREMENTS WITH 5
R
ESPECT TOTHIRDPARTYADMINISTRATIONSERVICES 6
FORGROUPHEALTHPLANS.— 7
(1) I
N GENERAL.—Clause (iii) of section 8
408(b)(2)(B) of such Act (29 U.S.C. 9
1108(b)(2)(B)), as amended by subsection (b)(1), is 10
further amended by adding at the end the following: 11
‘‘(VIII) With respect to a contract or ar-12
rangement with the covered plan in connection 13
with the provision of third party administration 14
services for group health plans, as part of the 15
description required under subclauses (III) and 16
(IV)— 17
‘‘(aa) the amount and form of any re-18
bates, discounts, savings fees, refunds, or 19
amounts received from providers and facili-20
ties, including the amounts that will be re-21
tained by the covered service provider; 22
‘‘(bb) the amount and form of fees ex-23
pected to be received from other service 24
providers in relation to the covered plan, 25
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including the amounts that will be retained 1
by the covered service provider as a fee, to 2
the extent feasible; and 3
‘‘(cc) the amount and form of ex-4
pected recoveries by the covered service 5
provider, including the amounts that will 6
be retained by the covered service provider 7
(disaggregated by category), as a result 8
of— 9
‘‘(AA) overpayments; 10
‘‘(BB) erroneous payments; 11
‘‘(CC) uncashed checks or incom-12
plete payments; 13
‘‘(DD) billing errors; 14
‘‘(EE) subrogation; 15
‘‘(FF) fraud; or 16
‘‘(GG) any other reason on behalf 17
of the covered plan.’’. 18
(2) A
NNUAL DISCLOSURE .—Clause (v) of sec-19
tion 408(b)(2)(B) of such Act (29 U.S.C. 20
1108(b)(2)(B)), as amended by subsection (b)(2), is 21
amended by adding at the end the following: 22
‘‘(IV) A covered service provider, with respect 23
to a contract or arrangement with the covered plan 24
in connection with providing third party administra-25
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tion services for group health plans, shall disclose, 1
on an annual basis not later than 60 days after the 2
beginning of each plan year, to a responsible plan fi-3
duciary, in writing, the following with respect to the 4
preceding plan year: 5
‘‘(aa) All direct compensation described in 6
subclause (III) of clause (iii). 7
‘‘(bb) All indirect compensation described 8
in subclause (IV) of clause (iii) received by the 9
covered service provider, an affiliate, or a sub-10
contractor (including such compensation de-11
scribed in subclause (VIII) of clause (iii)). 12
‘‘(cc) The aggregate amount for which the 13
covered service provider, an affiliate, or a sub-14
contractor received indirect compensation and 15
the estimated amount of cost-sharing incurred 16
by plan participants and beneficiaries as a re-17
sult. 18
‘‘(dd) The total gross spending by the cov-19
ered plan on all costs and fees arising under or 20
paid under the administrative services agree-21
ment with the covered service provider (not in-22
cluding any amounts described in items (aa) 23
through (cc) of clause (iii)(VIII)). 24
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‘‘(ee) The total net spending by the cov-1
ered plan on all costs and fees arising under or 2
paid under the administrative services agree-3
ment with the covered service provider. 4
‘‘(ff) The aggregate fees collected by the 5
covered service provider, an affiliate, or a sub-6
contractor from any source. 7
‘‘(gg) Any other information specified by 8
the Secretary through regulations or guidance 9
that may be necessary for a responsible plan fi-10
duciary to determine the reasonableness of the 11
contract or arrangement with the covered serv-12
ice provider any compensation paid under such 13
a contractor or arrangement, or any conflicts of 14
interest that may exist.’’. 15
(3) T
HIRD PARTY ADMINISTRATION SERVICES 16
FOR GROUP HEALTH PLANS DEFINED .—Clause 17
(ii)(I) of section 408(b)(2)(B) of such Act (29 18
U.S.C. 1108(b)(2)(B)), as amended by subsection 19
(b)(3), is amended by adding at the end the fol-20
lowing: 21
‘‘(hh) The term ‘third party administration 22
services for group health plans’ includes any 23
services provided by a covered service provider 24
to a covered plan with respect to the adminis-25
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tration of health benefits under the covered 1
plan, including— 2
‘‘(AA) the processing, repricing, and 3
payment of claims; 4
‘‘(BB) design, creation, and mainte-5
nance of provider networks; 6
‘‘(CC) negotiation of discounts off 7
gross rates; 8
‘‘(DD) benefit and plan design; nego-9
tiation of payment rates; 10
‘‘(EE) recordkeeping; 11
‘‘(FF) utilization review; 12
‘‘(GG) adjudication of claims; 13
‘‘(HH) regulatory compliance; and 14
‘‘(II) any other services set forth in 15
an administrative services agreement or 16
similar agreement or specified by the Sec-17
retary through guidance or rulemaking.’’. 18
(d) P
RIVACYREQUIREMENTS.—Section 408(b)(2) of 19
the Employee Retirement Income Security Act of 1974 20
(29 U.S.C. 1108(b)(2)), as amended by subsection (c), is 21
further amended by adding at the end the following: 22
‘‘(C) P
RIVACY REQUIREMENTS .—Covered serv-23
ice providers shall provide information under sub-24
paragraph (B) in a manner consistent with the pri-25
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vacy regulations promulgated under section 1
13402(a) of the Health Information Technology for 2
Clinical Health Act (42 U.S.C. 17932(a)), and con-3
sistent with the privacy regulations promulgated 4
under the Health Insurance Portability and Ac-5
countability Act of 1996 in part 160 and subparts 6
A and E of part 164 of title 45, Code of Federal 7
Regulations (or successor regulations) and shall re-8
strict the use and disclosure of such information ac-9
cording to such privacy, security, and breach notifi-10
cation regulations and such privacy regulations. 11
‘‘(D) D
ISCLOSURE AND REDISCLOSURE .— 12
‘‘(i) L
IMITATION TO BUSINESS ASSOCI -13
ATES.—A responsible plan fiduciary receiving 14
information disclosed under subparagraph (B) 15
may disclose such information only to the entity 16
from which the information was received, the 17
group health plan to which the information per-18
tains, or to that entity’s business associates as 19
defined in section 160.103 of title 45, Code of 20
Federal Regulations (or successor regulations) 21
or as permitted by the HIPAA Privacy Rule 22
(parts 160 and 164, subparts A and E of title 23
45, Code of Federal Regulations). 24
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‘‘(ii) CLARIFICATION REGARDING PUBLIC 1
DISCLOSURE OF INFORMATION .—Nothing in 2
this section shall prevent a group health plan or 3
health insurance issuer offering group health 4
insurance coverage, or a covered service pro-5
vider, from placing reasonable restrictions on 6
the public disclosure of the information de-7
scribed in this subparagraph, except that such 8
plan, issuer, or entity may not restrict disclo-9
sure of such information to the Department of 10
Labor. 11
‘‘(E) A
DDITIONAL PRIVACY REQUIREMENTS .— 12
‘‘(i) I
N GENERAL.—Covered service pro-13
viders shall ensure that information provided 14
under subparagraph (B) contains only summary 15
health information, as defined in section 16
164.504(a) of title 45, Code of Federal Regula-17
tions (or successor regulations). 18
‘‘(ii) R
ESTRICTIONS.—A group health plan 19
shall comply with section 164.504(f) of title 45, 20
Code of Federal Regulations (or successor regu-21
lations) with respect to any information re-22
ceived by the plan or disclosed to a plan spon-23
sor or any other entity pursuant to this section, 24
and a responsible plan administrator who is a 25
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plan sponsor shall act in accordance with the 1
terms of the agreement described in such sec-2
tion. 3
‘‘(F) R
ULE OF CONSTRUCTION .—Nothing in 4
this section shall be construed to modify the require-5
ments for the creation, receipt, maintenance, or 6
transmission of protected health information under 7
the privacy regulations promulgated under the 8
Health Insurance Portability and Accountability Act 9
of 1996 in part 160 and subparts A and E of part 10
164 of title 45, Code of Federal Regulations (or suc-11
cessor regulations).’’. 12
(e) R
ULE OF CONSTRUCTION.—Nothing in the 13
amendments made by this section shall be construed to 14
imply that a practice in relation to which a covered service 15
provider is required to provide information as a result of 16
such amendments is permissible under Federal law. 17
(f) E
FFECTIVEDATE.—The amendments made by 18
this subsection shall not apply to any contract or arrange-19
ment entered into prior to January 1, 2026. Such amend-20
ments shall apply to any contract or arrangement entered 21
into on or after to such date, including any extension or 22
renewal of a contract or arrangement, regardless of the 23
date on which the original contract or agreement (or any 24
previous extension or renewal) was entered into. 25
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SEC. 4. IMPLEMENTATION. 1
Not later than 1 year after the date of enactment 2
of this Act, the Secretary of Labor shall issue notice and 3
comment rulemaking as necessary to implement the provi-4
sions of this Act. The Secretary shall ensure that such 5
rulemaking— 6
(1) accounts for the varied compensation prac-7
tices of covered service providers (as defined under 8
section 408(b)(2)(B); and 9
(2) establishes standards for the disclosure of 10
expected compensation by such covered service pro-11
viders. 12
Æ
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