Competition and Transparency - Transparency of Health Prices and Data

Employers, policymakers, and health care advocates increasingly recognize that price and data transparency are essential tools for addressing the rising costs of medical care. Without clear, accessible pricing information, employers cannot make informed decisions or hold providers accountable for value and cost. ERIC and its partners have been at the forefront of efforts to codify and enforce transparency regulations, supporting legislation and regulatory action to require hospitals, insurers, and pharmacy benefit managers to disclose real prices and cost data. From federal claims data access to stronger compliance with transparency rules, these initiatives aim to empower employers and consumers with the information they need to drive smarter health care choices and rein in excessive costs.

  • Codification of the Transparency in Coverage Rules – The codification of the Transparency in Coverage and Hospital Transparency rules is critical to large employers because it ensures long-term, enforceable access to pricing data, allowing them to make informed decisions about health benefits, steer employees to high-value care, and hold providers accountable for costs. Without codification, these rules remain vulnerable to rollback or weak enforcement, undermining employers’ ability to control spending and improve plan value.
    • ERIC Recommendations on TiC Prescription Drug Machine-Readable File (MRF) Disclosure Requirements
      • ERIC’s recommendations focus on standardizing reporting requirements for hospitals and insurers, increasing enforcement and penalties when providers don’t adhere to transparency practices, ensuring employers have full access to their own claims data, integration of quality metrics related to safety, effectiveness, and long-term health outcomes, and shielding employers from being penalized if their health insurance carriers fail to comply with transparency regulations.
    • ERIC response to CMS Hospital Price Transparency Accuracy and Completeness Request for Information
      • Large employers support hospital price transparency but face major challenges due to inaccurate, incomplete, and inconsistently formatted data, which limits their ability to compare prices or manage costs effectively. ERIC urges CMS to define key terms, standardize data formats, strengthen enforcement, and leverage external data sources to ensure hospital pricing information is accurate, complete, and usable.
    • Pricing Transparency Stakeholder Letter
      • Joint support for robust transparency standards and enforcement.
    • Transparency Employer Group Letter
      • Employer-led appeal to strengthen pricing transparency regulations.
    • ERIC Support Letter for the Hospital Transparency and Compliance Enforcement Act (S. 468)
      • Advocates for stricter hospital compliance with transparency mandates.
  • Lower Costs, More Transparency Act (LCMTA) – LCMTA includes public disclosure of prices by health care providers requiring hospitals, diagnostic labs, imaging centers, and ambulatory surgical facilities to publish standard charges—including negotiated rates and cash prices—for hundreds of “shoppable” services. It also includes site-neutral payment policies for Medicare payments. The legislation ensures that employers and patients can access real-world pricing data across the care continuum—not just pharmacy costs.
    • EmployersRx Statement
      • Employer group statement on why transparency is vital for prescription and medical care costs.
    • Stakeholder Letter on LCMT and Price Transparency Acts
      • Consumers, patients, purchasers, employers philanthropy, and other health care stakeholders urged for Congress to address the nation’s health care affordability crisis by codifying the Hospital Price Transparency and TiC rules and addressing payment differentials across sites of care by enacting site neutral payment policy.
    • EmployersRx Letter on LCMT
      • The Purchaser Business Group on Health (PBGH), The ERISA Industry Committee (ERIC), American Benefits Council, National Alliance of Healthcare Purchaser Coalitions, Silicon Valley Employers Forum, HR Policy Association, and the Small Business Majority urge for passage of LCMT
    • Stakeholder Support Letter for LCMT
      • Consumers, employers, clinicians, and other health care stakeholders write in support of the bipartisan Lower Costs, More Transparency Act

Patients Deserve Price Tags Act (S. 2355/H.R. 5582)

This bill provides statutory authority for requirements for hospitals and health insurance plans to disclose certain information about the costs for items and services. Specifically, hospitals must publish in their list of standard charges certain rates negotiated with insurers, discounts for cash payments, and billing codes. Further, hospitals generally must publish the standard charges for the services provided by the hospital that may be scheduled in advance. Additionally, insurance plans must publish the in-network and out-of-network charges for covered items and services and the negotiated prices for covered prescription drugs. Plans must provide a tool for consumers to search for this cost information. Consumers also may request additional information about the costs of specific items or services under their plan.

Reps. John James (R-MI-10), Maggie Goodlander (D-NH-2), Jennifer Kiggans (R-VA-2), and Don Davis (D-NC-1) introduced H.R. 5582, the House companion bill to the Patients Deserve Price Tags Act (S. 2355), legislation that ERIC supports. The bill aims to improve health care price transparency, helping patients understand the actual cost of procedures, medications, and services before receiving care, and extends transparency reporting requirements across a range of health care providers, plans, and pharmacy benefit managers.

  • US PIRG Led Stakeholder Support Letter 
    • ERIC also joined U.S. PIRG and 52 other organizations in a letter supporting the bill that would improve price transparency.
  • Press release includes quote from ERIC’s President and CEO James Gelfand applauding the introduction as transparency will allow empower more selection of high quality, affordable health care, drugs, and services by patients.
  • ERIC President and CEO James Gelfand participated in a panel discussion during a briefing on Capitol Hill highlighting the need for Congress to advance health transparency legislation this year. Specifically, James and the other panelists called on Congress to enact stronger and more meaningful hospital and plan transparency requirements than exist today while expanding the transparency field to include additional stakeholders, as reflected in legislation introduced by Senators Roger Marshall (R-KS) and Hickenlooper (D-CO). 
  • Stakeholder Support Letter for Health Care PRICE Transparency Act 2.0 (118th Congress version)