Regulatory Updates
Departments Release Final Rule on Transparency in Coverage
Published October 05, 2026
The Centers for Medicare & Medicaid Services (CMS), the Department of Labor (DOL) and the Department of the Treasury jointly released a final rule amending the rules under the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code regarding price transparency reporting requirements for non-grandfathered group health plans, intended to improve the standardization, accuracy, and accessibility of public pricing disclosures in line with the goals of Executive Order 14221, “Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information.”
Regarding the in-network rate and out-of-network allowed amount machine-readable files, the final rules address:
- Adding new contextual files and additional data elements like product type, provider network name, and provider network identifier
- Changing the reporting level for aggregation of data
- Removing in-network rates for unlikely provider-to-service mappings
- Increasing the reporting period and lowering the claims threshold for out-of-network historical data; and reducing the reporting cadence (intended to lower administrative burden)
- Requiring dollar amount rates for “Percentage-of-Billed-Charges Arrangements”
- Requiring plans to add a link in the footer of the homepage of their website titled “Price Transparency” or “Transparency in Coverage” that routes directly to the publicly available web page that hosts the machine-readable files.
Cost-Sharing Information By Phone
The final rules requires that the cost-sharing information required to be made available through an internet-based tool or on paper, upon request, under the 2020 Transparency in Coverage rules also be made available over the phone, upon request, to satisfy the No Surprises Act cost-sharing tool provision (including for grandfathered group health plans that are not otherwise subject to these final rules).
Prescription Drug File Implementation Update
The departments will begin developing the initial schema for the "Prescription Drug File" in November 2026 and finalizing it in May 2027. Plans will be expected to publish their prescription drug files starting in December 2027 and monthly thereafter.
The regulations are effective December 7, 2026.
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