Just four days before the presidential election, the Trump Administration finalized its long-promised rule requiring insurers to share prices for healthcare services and patient cost-sharing with the public upfront. But payers say the rule will not achieve its aim of lowering prices.
The final rule, released yesterday by CMS, orders healthcare payers and self-insured plans to provide easy-to-understand and personalized information on cost-sharing and to publicly disclose the rates they pay to providers through online tools. Insurers and plans must also make this information available in paper form, if requested.
“Price transparency puts patients in control and forces competition on the basis of cost and quality which can rein in the high cost of care,” said Centers for Medicare & Medicaid Services Administrator Seema Verma in a statement. “CMS’ action represents perhaps the most consequential healthcare reform in the last several decades.”
The rule will provide about 200 million Americans with access to real-time price information, a CMS press release said. The regulation concerning health insurers comes about a year after CMS issued a similar rule requiring hospitals to publicize negotiated rates with insurers beginning in 2021.
But it will be about four years before healthcare consumers in the U.S. gain a full picture of prices from payers. Insurers must disclose negotiated rates and provide personalized estimates of patient out-of-pocket costs for 500 services and items, including drugs and medical equipment, beginning Jan. 1, 2023. Insurers must make that information publicly available for all items and services starting Jan. 1, 2024.
Further, the rule asks insurers to make their data files on healthcare costs available for research purposes. Researchers and technology developers can use the data to create solutions that will help people make healthcare decisions, including tools to compare prices between health plans. Insurers must make these data files public starting Jan. 1, 2022.
America’s Health Insurance Plans, a national payer association, released a statement noting its “disappointment” in the final rule.
The rule “will work to reduce competition and push healthcare prices higher — not lower — for American families, patients, and taxpayers,” the association said. “Competition experts, including the bipartisan Federal Trade Commission, agree that disclosing privately negotiated rates will reduce incentives to offer lower rates, creating a floor — not a ceiling — for the prices that drug makers, providers, and device makers would be willing to accept.”
In addition, the association said that three-quarters of commercial health insurance providers already offer price transparency tools.
Health Care Service Corp. is one of those insurers. The payer, one of the largest in the country, said in an emailed statement that their online tool “allows members to compare costs for over 1,600 healthcare services and understand their potential out-of-pocket expenses and cost-sharing obligations.”
The company is currently reviewing the final rule to determine next steps, including whether any modifications need to be made to the information and tools it currently offers members.
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