WASHINGTON, D.C. — Federal regulators have finalized new healthcare price transparency requirements that will change how insurers disclose negotiated medical rates, require telephone access to personalized cost estimates, and reduce reporting frequency, reshaping the pricing information available to patients, employers, and healthcare businesses.
The Centers for Medicare & Medicaid Services developed the regulations with the Departments of Labor and the Treasury to strengthen the existing Transparency in Coverage framework, which requires group health plans and insurers to publish information about healthcare prices.
The changes are intended to improve the accuracy and usability of pricing disclosures while reducing administrative costs associated with publishing large volumes of healthcare data.
Under the final rules, insurers and health plans will report pricing information quarterly rather than monthly. Federal officials said the reduced frequency will lower reporting burdens while preserving access to information needed to compare healthcare costs.
The regulations also eliminate duplicative information, add context to negotiated in-network prices and expand available data on out-of-network charges.
Additional requirements address the completeness and accuracy of published pricing information, a central concern as employers, researchers and technology companies increasingly use insurance pricing files to analyze healthcare costs.
The rules also require group health plans and insurers to provide personalized cost-sharing estimates by telephone, supplementing existing online tools.
The requirement is intended to give consumers another way to determine their expected financial responsibility before scheduling medical services.
“At the heart of this rule is a simple idea: 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,” CMS Administrator Mehmet Oz said.
The changes build on Transparency in Coverage regulations established during President Donald Trump’s first administration.
Those requirements created a framework for publishing negotiated healthcare rates, allowing consumers and third parties to examine pricing information that historically was difficult to obtain.
Federal officials said the latest revisions are designed to make that information more useful for comparing providers, evaluating insurance coverage, and developing consumer-facing cost estimation tools.
Employers could also use the revised disclosures to assess healthcare spending and compare prices across insurance networks.
The administration cited research indicating that prices among the most expensive 25% of healthcare services declined by 6.3% annually following the initial implementation of transparency requirements for hospitals and health plans.
The reported decline does not, by itself, establish that transparency requirements caused the price changes.
The regulations also establish a timetable for implementing standardized prescription drug pricing disclosures.
Federal agencies plan to begin developing the initial technical specifications for the Prescription Drug File in November 2026, with final specifications expected around May 2027.
Health plans and insurers are expected to begin publishing prescription drug pricing files using that format in December 2027, followed by monthly updates.
Unlike the revised quarterly reporting schedule for other pricing information, the prescription drug files will remain subject to monthly publication requirements once implemented.
Labor Secretary Keith Sonderling said the revisions would give workers and employers a clearer view of healthcare expenses through improvements to existing pricing disclosures.
The final rules implement Executive Order 14221, which directs federal agencies to strengthen access to healthcare pricing information.
The regulations are available through the Federal Register at https://www.federalregister.gov/public-inspection/2026-20447/transparency-in-coverage.
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