Health Care Price Transparency Act of 2023

The Health Care Price Transparency Act of 2023 aims to improve price transparency in health care services, primarily through requirements for hospitals, group health plans, and pharmacy benefits managers, and by limiting patient cost-sharing and adjusting Medicare payments. Title I, Health Care Price Transparency for Patients: Sec. 101 requires hospitals to publicly disclose standard charges and prices for shoppable services starting January 1, 2026. Sec. 102 mandates group health plans to provide individuals with cost-sharing estimates for specific items or services via a self-service tool or other disclosure methods. Sec. 103 prohibits pharmacy benefits managers from entering contracts that limit disclosure of information to plan sponsors and requires annual reports on drug pricing and rebates. Sec. 104 directs the Comptroller General to submit reports on health care transparency tools and reporting requirements by 2024 and 2028. Sec. 105 requires Medicare Advantage and prescription drug plans to report on provider ownership and pharmacy ownership every three years starting in 2025. Title II, Fair Prices for Patients: Sec. 201 limits cost-sharing for Medicare Part D drugs to the average net price or applicable cash price, effective January 1, 2027. Sec. 202 requires off-campus outpatient departments to obtain a separate health identifier and submit an attestation of compliance by January 1, 2026. Sec. 203 adjusts Medicare payments for off-campus outpatient department services to align with other payment systems, phased in over four years starting in 2025. Title III, Patient-Focused Investments: Sec. 301 requires Medicare Advantage plans to establish an electronic prior authorization program and meet transparency standards. Sec. 302 extends certain direct spending reductions under the Balanced Budget and Emergency Deficit Control Act.