Final Payer Price Transparency Rule Faces Uncertain Future

A final rule published on Oct. 29 requires health insurers and health plans in the individual and group markets to reveal the rates they negotiate with providers for health care services. The regulation was condemned by insurers, who argued it would drive up prices, but praised by one interest group representing self-insured health plans, which asserted the rule will improve competition and lower premiums. Industry experts say it’s too soon to draw across-the-board conclusions about the rule’s impact, and observe it is ripe for legal challenge.

To comply with the rule, starting on Jan. 1, 2023, health plans must offer members online shopping tools that allow them to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Effective one year later, those shopping tools will have to show the costs for all remaining items and services. Insurers must also meet a Jan. 1, 2022, deadline to “make publicly available standardized and regularly updated data files, which would open new opportunities for research and innovation to drive improvements within the healthcare market.”

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