Health Plan Price Transparency Requirements Final Rule Executive Summary

This document summarizes the October 29, 2020 final rule released by CMS requiring health plans to make an online price transparency tool that provides cost sharing and other information available to their members. For plan years starting on or after January 1, 2023, the rule requires health plans to offer an online shopping tool allowing consumers to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket (OOP) cost for 500 of the most shoppable items and services. The following year (effective for plan years starting on or after January 1, 2024), these shopping tools will be required to show the OOP costs for the remaining procedures, drugs, durable medical equipment and any other item or service they may need.

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