Health Care Price Certainty for All Americans Act

This bill requires hospitals, group health plans, and health insurance issuers to disclose prices and cost-sharing information to increase health care price transparency. It also mandates reporting on vertical integration among Medicare Advantage organizations and prescription drug plan sponsors, and provides funding for implementation.

Sec. 2, Hospital price transparency: Starting January 1, 2027, hospitals that receive Medicare payments must make public their standard charges, discounted cash prices, and payer-specific negotiated charges for items and services, including at least 300 shoppable services. They must post discounted cash prices for shoppable services in a public location and submit an annual attestation of accuracy. The Secretary must establish a uniform format by January 1, 2028.

Sec. 3, Health coverage price transparency: For plan years starting on or after January 1, 2029, group health plans must provide participants, upon request, cost-sharing information for specific items or services, including in-network rates, out-of-network maximum allowed amounts, estimated cost-sharing, deductible and out-of-pocket accumulations, and prior authorization requirements. This must be available through a real-time, plain-language self-service tool or paper/phone disclosure at no cost.

Sec. 4, Information on prescription drugs: Group health plans and health insurance issuers cannot restrict or penalize pharmacies from telling enrollees about any difference between the enrollee's out-of-pocket cost for a drug and the cash price without using insurance. This applies to plans under the Public Health Service Act, ERISA, and the Internal Revenue Code.

Sec. 5, Vertical integration accountability: For plan year 2028 and every third year thereafter, Medicare Advantage organizations with at least 25,000 enrollees must report taxpayer IDs of owned or controlled providers, and incentive payments and recoupments under financial risk arrangements. Prescription drug plan sponsors must report taxpayer IDs and National Provider Identifiers for owned or controlled pharmacies.

Sec. 6, Implementation funding: $65 million is appropriated to the Secretaries of Health and Human Services and the Treasury, and $35 million to the Secretary of Labor, for fiscal year 2027, available through 2032, for regulation drafting, guidance, enforcement, data collection, and other administrative duties to implement the bill.