Trump administration ups payer price transparency requirements

Healthcare price transparency remains a challenge, despite federal requirements for healthcare payers to disclose rates to consumers. The Trump administration is looking to overcome these challenges through updated requirements under the Transparency in Coverage, or TiC, rule.

CMS, along with the Department of Labor and the Department of the Treasury, jointly proposed major updates to the 2020 rule that requires most payers and health plans to disclose detailed cost-sharing and pricing information, including negotiated rates with providers, in a machine-readable format. They must also deliver personalized online tools for consumers to access pricing information.

However, compliance with the rule has been spotty. A recent study published in The American Journal of Managed Care found that three U.S. payers lag with compliance, lacking completeness of pricing data.

The Trump administration also identified three barriers to fully achieving the price transparency goals of the TiC rule. The barriers are inaccessibility due to the large size of the machine-readable files, data ambiguity due to a lack of contextual information alongside raw data and areas of misalignment with the Hospital Price Transparency rule that make comparing data across disclosures challenging.

Major updates proposed by the Trump administration seek to eliminate these barriers. The updates include:

• Requiring plans and payers to exclude data for services that providers are unlikely to perform in the in-network rate files.
• Reformatting the in-network rate files by provider network versus by plan, aligning more with how hospitals must disclose pricing data.
• Requiring change-log and utilization files so consumers can identify what has changed when in-network rate files are updated and which providers are actively delivering certain services and items.
• Decreasing the performance cadence for in-network rate and allowed amount files from monthly to quarterly.
• Upping the amount of out-of-network pricing information plans and payers must report through a reorganization of the allowed amount files by health insurance market type, decreasing the claims threshold to 11 or more claims and increasing the reporting period from 90 days to six months and the lookback period of data from 180 days to nine months.

The proposed updates would also strengthen requirements for price comparison tools by aligning with consumer protections under the No Surprises Act. Therefore, health plans and payers would have to deliver the same level of cost-sharing detail whether a consumer asks for the information online, on paper or by telephone.

These proposed updates to TiC requirements aim to make pricing information more accessible and actionable, according to CMS. However, the proposed updates notably do not include new requirements for prescription drug price transparency, which the TiC addresses but the federal government has yet to enforce.

"Every person deserves to know what their health care will cost without needing a team of analysts to decode it," CMS Administrator Mehmet Oz, M.D., said in a press release. "This overhaul takes a giant step toward that effort. By delivering clearer, more reliable pricing information, we are empowering Americans to take control of their care and creating a more competitive and affordable health system in the process."

The Trump administration has opened a 60-day comment period on the proposed updates, setting a deadline of Feb. 21, 2026.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.