Last week, the U.S. Departments of Labor, Health and Human Services (HHS) and the Treasury jointly announced new actions to advance healthcare price transparency, building on existing rules. These actions include new guidance and two Requests for Information (RFIs) that aim to make healthcare price data more accessible, accurate, and usable for consumers. As health plans work to comply with transparency requirements, understanding these developments is essential.
Key Implications for Health Plans
Stricter Enforcement and Compliance Pressure
CMS’s updated guidance makes clear that estimates are no longer acceptable for hospital pricing disclosures—only actual prices will meet compliance. With both health plans and hospitals under pressure to deliver accurate data, enforcement efforts are likely to intensify.
Implication: Health plans will need to ensure their provider data is both accurate and current. Failure to comply could lead to increased audits or penalties.
Need for More Usable and Consumer-Centric Data
One key theme in the updated guidance is usability. The government is encouraging health plans to eliminate “meaningless or duplicative” data, which often creates confusion for consumers. New technical format standards will help make most cost data easier to understand and act on.
Implication: Meeting compliance is no longer just a technical check-the-box task. Health plans need to view transparency as part of their digital experience strategy—delivering pricing data in ways that help members compare options, budget for care, and choose high-value providers.
Greater Scrutiny on Prescription Drug Price Data
The new RFI signals that federal agencies are looking closely at how prescription drug pricing data is reported. Currently, many plans face challenges in accessing the necessary data. The RFI invites feedback on how to improve this process and may lead to new requirements around data standardization, source transparency, and real-time access.
Implication: Health plans must assess how easily they can collect and report prescription drug pricing and prepare for potential changes to data reporting frameworks.
Preparing Your Team, Tech, and Tools for What’s Next
The direction is clear: transparency is evolving from a compliance requirement into a core pillar of healthcare strategy. Health plans that treat transparency as a strategic opportunity, rather than a regulatory burden, will be better positioned to:
- Build trust with members through honest, accessible cost information
- Enhance digital tools like provider search and cost estimators
- Support employer group sales by offering member-friendly cost visibility
- Differentiate in the market with intuitive, value-driven care navigation
To get there, health plans need scalable adaptable technology solutions that can ingest complex pricing data, align it with provider information, and deliver it in actionable ways across digital channels.
Kyruus Health is Here to Support You
We recognize that evolving price transparency regulations present both operational challenges and strategic opportunities. As regulations continue to take shape, we’re committed to helping health plans navigate the changes and stay ahead of new requirements.
We’ll be sharing additional guidance and resources as we continue to analyze the latest updates. In the meantime, visit our Healthcare Transparency Resource Page to learn how we’re supporting health plans in meeting transparency mandates and enhancing member experiences.