Even after a rule requiring unprecedented price transparency from hospitals was upheld in federal court, it remained unclear whether the health insurance industry would go to court to challenge a similar rule targeting their industry. Now, just months from when the “transparency in coverage” regulation is slated to go into effect, that question has an unexpected answer: A lawsuit has been filed, but not by health insurers.
Instead, the U.S. Chamber of Commerce and chief PBM trade group Pharmaceutical Care Management Association (PCMA) filed a pair of lawsuits seeking to strike down the transparency in coverage rule, which was proposed in November 2019 and finalized last October. While it isn’t clear yet how the courts will respond to the litigation, one health insurer trade group says plans are proceeding as though the rule will be implemented as written.
Under the rule, starting on Jan. 1, 2023, all non-grandfathered group and individual health plans must offer members online shopping tools that allow them to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Effective one year later, those shopping tools will have to show the costs for all remaining items and services.
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