HealthSparq Brief: Federal Price Transparency Requirements

On October 29, 2020, the Department of Health and Human Services (HHS), Department of Labor, and Department of the Treasury issued the final rule on price transparency for most non-grandfathered group health plans and issuers offering non-grandfathered health insurance coverage in the individual and group markets. As consumers pay greater shares of their health care coverage out of pocket, price transparency is seen as critical to help individuals understand their costs before receiving care. The rule requires personalized, out-of-pocket cost information, and underlying negotiated rates for all covered health care items and services, including prescription drugs, be shared with members or their authorized representatives. The final rules have a phased implementation from 2022 through 2024. There is time for health plans to get ahead of the deadlines and differentiate their offerings in market by getting prepared today.