The Centers for Medicare & Medicaid Services has finalized new regulations aimed at strengthening healthcare price transparency and giving consumers clearer information about costs before they receive care.
Updates to the Transparency in Coverage rules improve the underlying healthcare pricing data by reducing duplicative information, providing more context about in-network prices, and increasing available out-of-network pricing information, CMS said.
Reporting frequency for pricing information will change from monthly to quarterly schedules. The rules also require group health plans and health insurance issuers to provide consumers with personalized cost-sharing information by phone, in addition to online tools.
The changes are designed to help technology developers build better consumer-comparison tools and enable employers and researchers to better analyze healthcare markets, according to CMS.
CMS also established a timeline for a new Prescription Drug File. The agency will begin developing the initial schema in November 2026 and finalize it by May 2027. Health plans and insurers are expected to publish their Prescription Drug Files starting in December 2027 and monthly thereafter.
Recent data cited by CMS found that the top 25% of the most expensive healthcare service prices have dropped by 6.3% per year following earlier price transparency requirements on hospitals and health plans.