HHS updates healthcare price transparency rules for consumers

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new regulations that expand federal healthcare price transparency requirements, according to a statement from the agency.

The final rules update the existing Transparency in Coverage framework, developed in partnership with the Departments of Labor and the Treasury. Key changes include reducing duplicative pricing data, providing more context about in-network prices, increasing out-of-network pricing information, and shifting reporting frequency from monthly to quarterly.

Group health plans and health insurance issuers will be required to provide consumers with personalized cost-sharing information by phone, in addition to existing online tools.

HHS Secretary Robert F. Kennedy, Jr. commented: "Americans should know what their healthcare will cost before they receive it. These rules give patients clearer, more reliable information to compare costs, understand their coverage, and make informed decisions before they receive care."

CMS Administrator Dr. Mehmet Oz stated: "People should know what their health insurance will cover and what they will need to pay before receiving medical care, not after the bill arrives."

The agencies also outlined a timeline for a new Prescription Drug File requirement. Development of the initial data schema is planned to begin in November 2026, with finalization around May 2027. Health plans and issuers would be expected to publish Prescription Drug Files starting in December 2027, with monthly updates thereafter.

HHS cited data indicating that prices for the top 25% of the most expensive healthcare services dropped by 6.3% per year following the initial implementation of earlier price transparency requirements on hospitals and health plans, though the agency did not specify the source of this figure.

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