PRIA Logo™
119-hr-267119th CongressWALLET

Health Care PRICE Transparency Act

Sponsored By: Representative Davidson, Warren [R-OH-8]

Introduced

Summary

This bill would require hospitals and health plans to publish detailed prices, negotiated rates, cash discounts, and billing codes and to give consumers easy tools to find personalized cost estimates.

Show full summary
  • Hospitals must post a free, machine‑readable list of standard charges that includes gross charges, payer‑specific negotiated rates, de‑identified min and max negotiated charges, discounted cash prices, and billing codes like CPT, HCPCS, DRG, or NDC. They must cover at least 300 shoppable services or as many as they offer and may meet the rule with an internet price‑estimator that shows what a patient will owe. Penalties for noncompliance can reach $300 per day.
  • Health plans and Exchanges must disclose in‑network and out‑of‑network charges, negotiated rates and historical net prices for covered prescription drugs, and provide an internet self‑service tool with real‑time cost‑sharing results. Plans must also supply a paper list on request with no fewer than 20 providers mailed within two business days.
  • The disclosure rules extend beyond individual market plans to group health plans, including self‑insured and fully insured plans, improving price visibility across more types of coverage.

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Free to download

Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Real-time cost estimates from your health plan

If passed, your health plan would need to give real-time cost estimates for care and drugs. The estimate would show what you would owe after your deductible and any cost-sharing reductions. It would show how much you already paid toward your deductible and out-of-pocket limit. You could see in-network negotiated rates and out-of-network allowed amounts or other payment estimates. For drugs, it would show the negotiated rate and a historical net price that reflects rebates. Results would list items in any bundle and note any steps needed before coverage applies. A free online self-service tool would be required, with plain language, real-time results, and search by provider or all in-network providers. On request, a paper response listing at least 20 providers would be mailed within two business days.

Hospitals must post prices or face fines

Hospitals would have to post their prices online for free in a simple, machine-readable format. Each list would include clear descriptions and billing codes. It would show gross charges, payer-specific negotiated rates with payer and plan names, de-identified minimum and maximum rates, and the discounted cash price. Hospitals would need to post at least 300 shoppable services, including the CMS-listed ones, or all services if they offer fewer. They could meet this by offering a free online estimator for at least 300 services that gives on-the-spot estimates and is searchable by description, code, and payer, without payment or personal data. Hospitals that do not comply could be fined up to $300 per day until they fix it.

Sponsors & CoSponsors

Sponsor

Davidson, Warren [R-OH-8]

OH • R

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov
Back to Legislation