“You’re not allowed to even talk about it when you’re going to a hospital or see a doctor. And this allows you to go out and talk about it,” the president said as he signed the order, per Reuters. “It’s been unpopular in some circles because people make less money, but it’s great for the patient.”
Six notes for payers:
1. The order directs HHS, and the Labor and Treasury departments to “rapidly implement and enforce” price transparency regulations that President Trump introduced during his first term, which he accused the Biden administration of “slow walking,” according to a Feb. 25 White House fact sheet.
2. The departments will ensure payers disclose actual prices, not estimates, and take action to “make prices comparable across hospitals and insurers, including prescription drug prices.” The departments will also update their enforcement policies to ensure payers are in compliance with requirements to make prices transparent.
4. President Trump signed the original executive order on healthcare price transparency in 2019. Beginning in July 2022, payers were required to disclose in-network provider rates for covered items and services; out-of-network allowed amounts and billed charges for all covered items and services; and negotiated rates and historical net prices for covered prescription drugs administered by providers.
In 2023, payers were required to provide an internet-based price comparison tool that allows members to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers for 500 items and services. By 2024, price comparison tools had to include all services, including prescription drugs. President Trump’s new executive order specifically aims “to hold health plans accountable for making drug prices transparent.”
5. To date, 18 hospitals have been fined by CMS for alleged price transparency violations. No insurers have been publicly fined for noncompliance.
Turquoise Health, a company that develops price transparency software, scored 183 payers in 2023 on the completeness of their publicly available reported rates, the accessibility of posted file sizes and the parsability of files. From that, 48 payers were given top scores for completeness, accessibility and parsability.
6. Insurers have been using price transparency data to improve value-based care and enhance decision-making processes, though there have been major challenges in making the data fully accessible and useful for consumers.
In 2023, researchers at Elevance Health identified several limitations in the price transparency data required by payers, including inaccurate pricing, incomplete provider information, and discrepancies between prices and actual care utilization.
