CMS Finalizes Rule Requiring Payers to Post Negotiated Rates, Cost-sharing Data

The Centers for Medicare & Medicaid Services (CMS) finalized a rule requiring private insurers to provide members with upfront prices negotiated with providers–including cost-sharing data. Starting in 2023, payers will be required to offer an online shopping tool that includes out-of-pocket cost estimates and negotiated prices for 500 common healthcare items and services—to be extended to all services in 2024. Payers will also be required to post in-network negotiated provider rates, out-of-network coverage rates and in-network drug pricing starting in 2022. America’s Health Insurance Plans (AHIP) President and CEO Matt Eyles said the rule will “reduce competition and push health care prices higher, not lower, for American families, patients and taxpayers.” Read more here.

(Source: Ricardo Alonso-Zaldivar; Associated Press; 10/29/20)