Lower Costs, More Transparency Act

# Summary of "Lower Costs, More Transparency Act" Legislative Document This comprehensive healthcare legislation contains numerous provisions aimed at increasing transparency in healthcare pricing, reducing hidden fees, and improving access to health data for patients and plan fiduciaries. **Key Provisions:** 1. **Healthcare Pricing Transparency (Section 105):** - Requires healthcare providers to disclose pricing information - Mandates price transparency for hospital services, physician services, and medical devices - Requires Medicare Advantage plans to provide clear pricing information 2. **Pharmacy Benefit Transparency (Section 106):** - Requires pharmacy benefit managers (PBMs) to disclose all compensation structures - Prohibits "gag clauses" that prevent pharmacies from informing patients about price differences - Mandates detailed disclosure of rebates, discounts, and other compensation arrangements 3. **Plan Fiduciary Access to Health Data (Section 401):** - Requires group health plans to allow fiduciaries to audit de-identified claims data - Prohibits contracts that limit access to health data or unduly delay audits - Requires annual attestations of compliance with transparency requirements 4. **Hidden Fees Disclosure (Section 402):** - Strengthens disclosure requirements for pharmacy benefit managers and third-party administrators - Requires detailed annual disclosure of all compensation, rebates, and fees - Defines "clawback" and requires disclosure of recovery amounts 5. **Prescription Drug Price Information (Section 403):** - Prohibits health plans from restricting pharmacies from informing patients about price differences - Requires clear definition of "out-of-pocket cost" for prescription drugs 6. **Funding and Implementation:** - Appropriates $25 million for implementation of transparency provisions - Requires annual reporting on implementation funding - Establishes effective dates for various provisions (primarily 2025-2028) **Overall Impact:** The legislation aims to create a more transparent healthcare marketplace by requiring detailed disclosure of pricing structures, eliminating restrictions on price discussions between pharmacies and patients, and giving plan fiduciaries greater access to health data for better decision-making. The provisions target hidden fees in pharmacy benefit management, improve Medicare transparency, and support community health centers and other healthcare programs.