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New Interim Rule to Improves Transparency and Oversight of Prescription Drug and Medical Costs

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Additional steps to lower health care costs by requiring health insurance issuers, employer-based health plans, and other group health plans to report on prescription drug and health coverage costs, have been announced by the Centers for Medicare and Medicaid Services (CMS). The requirement was implemented through an interim final rule with request for comments issued by the Departments of Health and Human Services (HHS), Labor, the Treasury (collectively, the Departments), and the Office of Personnel Management.  The rule is the fourth rule in a series that the Departments are issuing to implement the No Surprises Act and transparency requirements of the Consolidated Appropriations Act (CAA), 2021.

The interim final rule requires health plans, health insurance issuers offering group or individual health insurance coverage, and health benefits plans offered to federal employees to submit key data to the Departments, which will work through the HHS Assistant Secretary for Planning and Evaluation (ASPE) to publish a report on prescription drug pricing trends and rebates, as well as their impact on premiums and consumers’ out-of-pocket costs. The data submission requirements include information on average monthly premiums and drug spending for patients, compared to their employers and/or group health plans/health insurance issuers.

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