A New Wave of Healthcare Price Transparency Enforcement
On May 22, 2025, the Departments of Labor, Health and Human Services, and the Treasury announced new steps to strengthen enforcement of healthcare price transparency regulations. These actions focus on improving compliance with the Transparency in Coverage (TiC) and Hospital Price Transparency (HPT) rules, particularly around prescription drug pricing.
At Excess Reinsurance, we view this as a critical moment for employers. Enhanced transparency isn’t just a regulatory requirement; it’s a fiduciary imperative. Employers must be ready to evaluate plan performance, pricing arrangements, and vendor accountability in light of these new developments.
What’s Changing
While plans have begun submitting RxDC files as required under the Consolidated Appropriations Act of 2021, enforcement and public accessibility of prescription drug price data under TiC remain limited but are poised to advance. The agencies are now requesting public input on how to implement this requirement, signaling that change is imminent. At the same time, updated technical standards for MRFs take effect in February 2026, requiring employers and their service providers to adjust how data is reported.
The Centers for Medicare and Medicaid Services (CMS) is also tightening HPT rule enforcement by requiring negotiated rates and cash prices rather than estimates. While plans aren’t directly responsible for hospital disclosures, the quality of this data impacts the effectiveness of price transparency tools used by employers and members.
What Employers Should Do Now
TiC and HPT were both designed to help employers better understand healthcare costs and fulfill their responsibilities under ERISA. These rules allow employers to monitor plan spending, ensure that provider quality aligns with cost, and determine whether vendors are being paid reasonable compensation. For years, a lack of pricing transparency has made it difficult for employers to perform these duties effectively. With more data now available and additional enforcement actions on the horizon, employers have new opportunities to use transparency tools to manage healthcare costs and reduce fiduciary risk.
Self-funded plan sponsors should pay particular attention. Unlike fully insured arrangements, the responsibility for compliance ultimately rests with the employer.
These regulatory moves reinforce a long-term trend: transparency is reshaping healthcare purchasing. Excess Reinsurance continues to monitor these changes closely and is here to help you stay compliant, informed, and ahead of the curve.