Rule Finalized Forcing Payers to Post Negotiated Rates, Cost-sharing Data

The Trump administration has finalized a rule that will require private insurers to provider members with upfront prices – including real-time cost-sharing estimates – that they have negotiated with providers. The details are still being worked out, but a time table of how the rule will go into effect is outlined below.

2022
  • Insurers must post online a series of documents that include their in-network negotiated provider rates, out-of-network coverage rates, and in-network drug pricing.
2023
  • A platform will need to be created by insurers that include an out-of-pocket cost estimate and negotiated prices for 500 of the most common services. The hope is that third-party developers will step in and aid in the development once the data becomes available online.
2024
  • The requirements in 2022 and 2023 will be extended and required for all service types.

Although the Trump Administration has finalized the rule, there is already significant pushback across the industry. Insurers are likely to lead the fight against the new rule as it argued that launching such tools would come at a high cost, and providing the data would confuse their members.

The Blue Cross Blue Shield Association recently noted the firm Bates White estimated that setting up and maintaining the mandated transparency tool would cost the insurer $13.63 million, a figure 26 times higher than the administration’s $510,000 estimate.

Health plans also argued that posting pricing data without quality information could lead patients to believe that higher prices equate to higher quality, driving up costs.

AdvantEdge