Two regulations advance the Trump Administration’s commitment to increasing price transparency.
Hospitals and insurers in the United States will now be required to disclose 'negotiated' rates and provide transparency (for the first time).
As directed by President Trump's Executive Order on Improving Price and Quality Transparency in American Healthcare, the Department of Health and Human Services has announced that the Centers for Medicare & Medicaid Services (CMS) is issuing two rules to increase drug price transparency:
i. Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule.
ii. The Transparency in Coverage Proposed Rule.
Administration officials said the final payment ruling will compel hospitals to publicize rates negotiated with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility. Insurers, under the transparency proposal, will have to create a web-based tool for beneficiaries that discloses the list price, the negotiated rate, cost sharing and the amount left on a plan deductible, as well as allowable out-of-network rates.
Insurers and hospitals have argued that price transparency could actually drive prices higher.