Transparency in Coverage Act

The Transparency in Coverage Act (HR 4507) requires group health plans and health insurance issuers to provide clear, accessible pricing information to the public and plan participants. It mandates disclosures about cost-sharing, in-network rates, denied claims, and other financial details in plain language, with information available online by January 10, 2025. The bill also requires publishing rate and payment information in machine-readable formats, with real-time access through APIs beginning January 1, 2026. This applies to most employers with group health plans, aiming to help people understand healthcare costs before receiving care. The legislation includes specific transparency requirements for pharmacy benefit managers regarding drug pricing, rebates, and spending data.