Health Insurers Must Now Reveal Real Drug and Service Prices
Published Date: 10/6/2026
Rule
Summary
Starting soon, health plans and insurers must share clearer, easier-to-understand price info for medical services and drugs. This helps you see what in-network and out-of-network costs really look like, with more details and better updates. These changes affect most group and individual health plans and kick in with new reporting rules to make healthcare pricing more transparent and fair.
Analyzed Economic Effects
8 provisions identified: 7 benefits, 1 costs, 0 mixed.
Market‑level and network‑level reporting
The rule requires separate out-of-network Allowed Amount machine-readable files organized by defined "health insurance market" (individual, large group, small group, and certain self-insured group markets) and moves reporting toward network-level aggregation. The Departments finalized a definition of "health insurance market" to support these separate files.
Expanded out‑of‑network historical reporting
The final rules increase the reporting period and lower the claims threshold for out-of-network historical data, and they change reporting cadence. These changes are intended to include more out-of-network payment history in the machine-readable files.
Attestation and stronger enforcement emphasis
The Departments finalized an attestation requirement for plans and issuers to help ensure the accuracy of published machine-readable files, and stated they will prioritize compliance and enforcement using existing authorities, including corrective actions and civil monetary penalties.
Plan sponsor/TPA reporting responsibility clarified
The final rules include special rules that articulate responsibility for group plans that enter into written agreements with health insurance issuers or third‑party administrators (TPAs) to provide the required machine-readable file information. Plans that rely on TPAs should ensure their contracts enable access to required data.
New price data fields required
Health plans and insurers must add new data elements to their public machine-readable price files, including product type, provider network name, and provider network identifier. These additions are part of the final Transparency in Coverage rule that updates the machine-readable file requirements.
Better findability: text file and footer links
Plans and issuers must publish a text file with contact information for the machine-readable files and include a footer on websites with URLs to those files. These requirements are intended to make it easier for the public and developers to find the price files.
Phone access for price tools; No Surprises Act tie‑in
If a plan or issuer makes pricing information available via an online tool or on paper (upon request), the rule requires that the same pricing information also be available by phone. Meeting this phone requirement also satisfies the requirements of section 114 of the No Surprises Act, including for grandfathered group health plans and grandfathered issuers.
Exclude unlikely provider‑to‑service rates
The Departments finalized removing in-network rates from the machine-readable files for provider-to-service mappings that are unlikely (providers unlikely to provide the listed service). This change aims to reduce misleading or irrelevant rate entries in published files.
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Key Dates
Department and Agencies
Related Federal Register Documents
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