H.R. 9645: Health Care Price Certainty for All Americans Act

This bill would expand health care price transparency and reporting requirements for hospitals, labs, imaging centers, ambulatory surgical centers, health plans, pharmacies, and pharmacy benefit managers (PBMs).

Price Disclosure Requirements

Hospitals, labs, imaging providers, and ambulatory surgical centers would have to publicly disclose their standard charges and prices for services that patients can shop for. These disclosures would need to be presented in standardized formats, and the organizations would have to attest that the information is accurate. Health plans and ambulatory surgical centers would also need to provide accessible, real-time information about costs, rates, and patient payment obligations through public self-service tools or machine-readable files.

Health Plan Reporting

Health plans would be required to publish quarterly machine-readable data on prices and payments. They would also need to provide plain-language instructions for using their search tools, issue annual summary reports by 2029, and submit attestations showing they are complying with the law. The bill also requires accessibility for people with limited English proficiency and for people with disabilities.

Rules on Pharmacy Price Information

The bill would ban contracts that prevent pharmacies from telling patients when paying cash would cost less than using their health plan. It would also block pharmacies and PBMs from using gag clauses that restrict disclosure of drug prices.

Ownership and Market Transparency in Medicare Advantage and Part D

The bill would require additional reporting on ownership and financial risk arrangements in Medicare Advantage and Part D plans. It would also direct the Medicare Payment Advisory Commission to review vertical integration in these markets, meaning ties between insurers, PBMs, pharmacies, and related businesses.

Enforcement

Federal agencies would monitor compliance, conduct audits, require corrective action plans when needed, and impose penalties for violations. The bill also provides $100 million for implementation and enforcement.

Relevant Companies

• None found