DOL, Treasury, HHS Finalize Healthcare Pricing ‘Transparency’ Rules

The Departments of Health and Human Services, Labor and Treasury finalized new regulations updating “Transparency in Coverage,” a federal framework for employer-sponsored health plans and health insurers. According to the agencies, the regulations will make healthcare pricing information more useful and accessible to consumers.

The final rule, released Monday, alters transparency reporting requirements under the Public Health Service Act, the Employee Retirement Income Security Act and the Internal Revenue Code for ERISA-covered group health plans, nonfederal governmental group health plans and certain church plans.

The regulations largely finalize changes proposed in December 2025 and are intended to address longstanding criticism that the vast amounts of pricing data published under the original Transparency in Coverage rules have been difficult for employers, researchers and consumers to navigate.

“These rules give patients clearer, more reliable information to compare costs, understand their coverage and make informed decisions before they receive care,” said Secretary of Health and Human Services Robert F. Kennedy Jr. in a statement.

While the agencies framed the changes as an effort to improve accessibility to pricing data, the final rule deepens federal oversight of health plan pricing and operations; places new compliance and governance demand on health plans and insurers; and reduces the frequency of public pricing disclosures.

Changes to Reporting Requirements

Building on initial calls for healthcare transparency under the Affordable Care Act, the Transparency in Coverage regulations were first finalized in 2020, during President Donald Trump’s first term. Since 2022, health plans and insurers have been required to publish machine-readable files containing in-network negotiated rates, out-of-network allowed amounts, and prescription drug pricing information.

Federal officials said in the announcement that the original disclosures often lacked context, contained excessive amounts of data, and were difficult for consumers to use when comparing costs.

“This rule helps improve the standardization, accuracy, and accessibility of pricing disclosures to put Americans and their families in a better position to understand the cost of their health care coverage and make informed decisions about their own care,” said Deputy Secretary of the Treasury Francis Brooke, in a statement.  

Under the final rule, health plans and insurers will be required to:

• Update machine-readable files quarterly, rather than monthly;
• Report pricing information by provider network, rather than individual health plan;
• Include additional contextual information, such as provider network names, identifiers and product types;
• Remove certain “ghost rates”—negotiated rates tied to provider-service combinations that are unlikely to occur in practice;
• Lower the claims threshold for reporting out-of-network historical payment data to 11 claims from 20 claims;
• Provide personalized cost-sharing information by telephone, in addition to online tools and paper disclosures upon request; and
• Improve the accessibility of publicly available machine-readable files through standardized file location in addition to contact information requirements.

The rule also requires in-network negotiated rates to be reported as specific dollar amounts, rather than percentages or formulas, a change regulators said will make pricing information easier to understand and compare.

Certain changes could make files easier to navigate, but may result in less plan-specific visibility than the previous reporting.

In addition, health plans and insurers will be required to have a CEO, president or similarly authorized official attest to the accuracy of the reported information.

The regulations take effect on December 5, with various data reporting requirements phasing in during 2027.