PBMs, Not Insurers, Lead Legal Challenge of Transparency Rule

Even after a rule requiring unprecedented price transparency from hospitals was upheld in federal court, it remained unclear whether the health insurance industry would go to court to challenge a similar rule targeting their industry. Now, just months from when the “transparency in coverage” regulation is slated to go into effect, that question has an unexpected answer: A lawsuit has been filed, but not by health insurers.

Instead, the U.S. Chamber of Commerce and chief PBM trade group Pharmaceutical Care Management Association (PCMA) filed a pair of lawsuits seeking to strike down the transparency in coverage rule, which was proposed in November 2019 and finalized last October. While it isn’t clear yet how the courts will respond to the litigation, one health insurer trade group says plans are proceeding as though the rule will be implemented as written.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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