Executive Order Pushes for Transparent Healthcare Pricing
- Boutwell Fay
- 6 days ago
- 2 min read
Updated: 21 hours ago
A recent Executive Order (EO), “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” aims to increase consumer access to healthcare pricing information by increasing enforcement of regulations released pursuant to an EO issued in 2019.
The Recent Executive Order
Specifically, the EO directs that by May 26, 2025, the IRS, DOL, and HHS take “all necessary and appropriate action to rapidly implement and enforce” those existing regulations, including:
Price Disclosure: requiring the disclosure of the actual prices (not estimates) of items and services;
Pricing Standardization: standardizing pricing information to ensure it is easily comparable across hospitals and health plans; and
Enforcement: updating enforcement policies to ensure transparent reporting of complete, accurate, and meaningful data.
The Existing Law
The 2019 EO, “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First,” directed federal agencies to require health plans and hospitals to publicly post the prices of “shoppable” services (common services offered by multiple providers through the market) to allow patients to research and compare services before making informed choices based on price and quality. This led to the issuance of two key regulations that require hospitals to publish pricing information and health plans to publish negotiated rates and net prices for prescription drugs.
The recent EO may affect compliance with other existing law, as the mandate to provide exact prices, rather than estimates, differs from the No Surprises Act’s requirement to provide only estimated costs.
What Plan Sponsors Need to Know
Plan sponsors should conduct internal audits and prepare for enforcement action. To increase compliance, sponsors should work with their plan service providers to ensure compliance with existing transparency requirements. If participants receive the pricing information from a third-party service provider, plan sponsors should confirm their service agreements require the third parties to provide all required information in compliance with federal law. Consequences of noncompliance may include required corrective action and civil monetary penalties.
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