New rule to impose price transparency requirements on group health plans

Today, the U.S. Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (the Departments) issued new final regulations that will impose price transparency requirements on group health plans.  This is a very big deal.  This rule will require most group health plans to disclose price and cost-sharing information to participants, beneficiaries, and enrollees. The Departments are finalizing a requirement to give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability, through an internet based self-service tool. This requirement is intended to empower consumers to shop and compare costs between specific providers before receiving care.

Through this final rule, plans will also be required to disclose on a public website their in-network negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs. Making this information available to the public is intended to drive innovation, support informed, price-conscious decision-making, and promote competition in the health care industry.

It appears the requirements will be phased in over time, with some requirements applying for plan years beginning in 2022 and others in 2023, with all requirements effective by plan years beginning in 2024.  The regulations are just under 600 pages – but more to come on this later.