Lower Costs, More Transparency Act of 2026
- Sponsor
- Rep. Guthrie, Brett [R-KY-2]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Jul 21, 2026
Bottom line
The bill aims to empower consumers and foster competition by making healthcare prices transparent across a broad spectrum of providers and payers, but it imposes significant new compliance burdens on the healthcare industry.
What it actually does
This bill mandates extensive price transparency requirements across the healthcare sector, including hospitals, clinical laboratories, imaging centers, ambulatory surgical centers, and health insurance plans. It requires these entities to publicly disclose standard charges, negotiated rates, and consumer-friendly prices for shoppable services, and for health plans to provide individualized cost-sharing information and public data files of negotiated rates. It also introduces new disclosure requirements for Pharmacy Benefit Managers (PBMs) regarding drug 'spread pricing'.
Proponents argue
Proponents argue that this bill will empower consumers to make more informed healthcare decisions by providing clear, accessible pricing information, thereby fostering competition among providers and payers. They contend that increased transparency will drive down healthcare costs, reduce out-of-pocket spending for patients, and shed light on opaque practices, particularly in drug pricing through PBM disclosures.
Opponents contend
Opponents contend that the bill imposes substantial administrative and IT burdens on healthcare providers and health plans, leading to significant compliance costs that could be passed on to consumers through higher premiums. They also express concerns that public disclosure of negotiated rates could lead to price collusion among providers or a 'race to the top' in pricing, rather than the intended cost reduction, and that PBM disclosures could reveal proprietary business models.
The bill is moderately complex due to its technical language and cross-references to existing law, requiring a dedicated read to fully grasp its implications. The time given for analysis is adequate for an informed reader.
Section 2(a) (amending SSA Title XVIII, Part E) and Section 2(b) (amending PHSA Section 2718)
Mandated Hospital Price Disclosure
This provision requires all hospitals (including critical access and rural emergency hospitals) to publicly disclose their standard charges for all items and services, as well as consumer-friendly prices for at least 300 'shoppable services'. This includes gross charges, discounted cash prices, median cash prices for self-pay patients, payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges. The information must be in a uniform, machine-readable format for standard charges and a consumer-friendly format for shoppable services, with an annual attestation of completeness and accuracy.
Supporters argue
Supporters argue that making hospital prices transparent will empower patients to shop for care, foster competition among hospitals, and ultimately drive down healthcare costs. They believe it will also increase accountability for pricing practices.
Critics contend
Critics contend that the detailed disclosure requirements impose a massive administrative burden and significant IT costs on hospitals. They also argue that publicly disclosing negotiated rates could lead to price collusion among hospitals or a 'race to the top' in pricing, rather than genuine competition.
Tradeoffs
The provision balances the goal of consumer empowerment and market competition through transparency against the administrative burden on hospitals and concerns about the disclosure of commercially sensitive negotiated rates.
Section 3 (amending SSA Section 1846)
Clinical Diagnostic Laboratory Test Price Transparency
This section requires applicable clinical diagnostic laboratories to make publicly available on an internet website the discounted cash price (or gross charge if no cash price exists) for each 'specified clinical diagnostic laboratory test' they furnish. This information must be updated annually and include an attestation of accuracy. It also specifies that the price must include any ancillary items or services normally furnished as part of the test.
Section 4 (amending SSA Section 1899D)
Imaging Services Price Transparency
This provision requires providers and suppliers of specified imaging services (excluding those already covered by hospital or ASC transparency rules) to publicly disclose the discounted cash price (or gross charge) for each such service on an internet website. This information must be updated annually and include an attestation of accuracy. The Secretary is tasked with establishing a uniform method and format for this disclosure.
Section 5 (amending SSA Section 1834)
Ambulatory Surgical Center (ASC) Price Transparency
This section requires ambulatory surgical centers (ASCs) to publicly disclose their standard charges for all items and services, as well as consumer-friendly prices for at least 300 'shoppable services'. This includes gross charges, discounted cash prices, and median cash prices for self-pay patients. The information must be in a uniform, machine-readable format for standard charges and a consumer-friendly format for shoppable services, with an annual attestation of completeness and accuracy.
Section 6(a) (amending IRC Section 9819, PHSA Section 2799A-4, and ERISA Section 719)
Health Coverage Cost-Sharing Transparency for Individuals
This provision requires group health plans and health insurance issuers to provide individualized cost-sharing information to participants or beneficiaries upon request, starting January 1, 2028. This includes in-network rates, maximum allowed amounts for out-of-network providers, estimated cost-sharing, accumulated deductible/out-of-pocket maximums, frequency/volume limitations, prior authorization requirements, and financial incentives. This information must be available through a real-time, internet-based self-service tool or other requested formats. For 'applicable spread price drugs,' it requires disclosure of the difference between payment and reimbursement amounts and a plain language explanation of spread pricing.
Section 6(a) (amending IRC Section 9819, PHSA Section 2799A-4, and ERISA Section 719)
Public Disclosure of Health Coverage Rate and Payment Information
This provision requires group health plans and health insurance issuers (excluding grandfathered plans) to make public extensive rate and payment information in machine-readable files, starting January 1, 2028. This includes in-network rates for non-drug items/services (with provider claim history), in-network rates for drugs (by NDC, with average paid amounts accounting for rebates/discounts), and billed/allowed amounts for out-of-network services. These files must be updated quarterly (in-network/drug data) or monthly (out-of-network data) and be accessible via a publicly available website. Annual summary data files are also required, providing aggregated statistics on rates and payment models.
Section 6(f) (amending IRC Section 9819, PHSA Section 2799A-4, and ERISA Section 719)
Pharmacy Benefit Manager (PBM) Spread Pricing Disclosure
This provision requires Pharmacy Benefit Managers (PBMs) to disclose to the health plans or issuers they serve a list of 'applicable spread price drugs' and, for each such drug and pharmacy, the difference between the 'specified payment amount' (what the PBM pays the pharmacy) and the 'specified reimbursement amount' (what the plan pays the PBM). This disclosure is intended to ensure that the cost-sharing and rate information provided to consumers and the public is timely and accurate.
These clauses specify that the Secretary cannot subject a hospital to civil monetary penalties under both the Social Security Act and the Public Health Service Act for the same period of noncompliance with price transparency requirements. It also prioritizes the imposition of penalties under the PHSA over the SSA if a hospital violates both.
Section 2(a)(4)(B)(viii) (SSA 1899D(a)(4)(B)(viii)) and Section 2(b)(4)(B)(viii) (PHSA 2718(f)(4)(B)(viii))
Why it matters:This is standard legislative practice to prevent excessive penalties for regulated entities and to clarify which federal authority takes precedence when overlapping statutes apply. It ensures a streamlined and fair enforcement process.
Case for: This provision prevents hospitals from being penalized twice for the same non-compliance, offering a measure of fairness and predictability in enforcement. It also clarifies the regulatory landscape for both hospitals and federal agencies.
Case against: No significant case against this provision, as it is a procedural clarification designed to prevent regulatory overreach and ensure consistent application of penalties.
Estimated impact: Reduces the potential cumulative financial burden on hospitals for non-compliance with price transparency rules, ensuring that enforcement actions are coordinated rather than duplicative.
These clauses explicitly sunset the existing 'maintenance of price comparison tool' requirement for group health plans, effective for plan years beginning on or after January 1, 2028. This means the prior, less extensive transparency rules are replaced by the new, more comprehensive requirements introduced in this bill.
Section 6(a)(1)(A)(iii) (IRC 9819(a)(2)), Section 6(a)(2)(C) (PHSA 2799A-4(a)(2)), Section 6(a)(3)(A)(iii) (ERISA 719(a)(2))
Why it matters:This is standard legislative practice when a new, more comprehensive regulatory framework is intended to supersede and replace an older, less extensive one. It ensures a clear transition without overlapping or conflicting mandates.
Case for: The sunset provision streamlines regulations by replacing an older, less robust transparency requirement with the new, more detailed and expansive mandates of this bill. It avoids confusion and ensures that regulated entities focus on complying with the latest standards.
Case against: There is no specific opposition to the sunset itself, as the new provisions are designed to be more comprehensive. Any opposition would likely be directed at the new, more stringent requirements rather than the removal of the older ones.
Estimated impact: Ensures a smooth regulatory transition for group health plans and health insurance issuers, preventing them from being subject to two different sets of price transparency rules simultaneously. It directs compliance efforts towards the new, more demanding standards.
These definitions and applicability clauses specify that certain laboratories and imaging providers are exempt from the new transparency requirements if their services' standard charges and prices are already made public by a 'specified hospital' (under SSA 1899D), a 'hospital' (under PHSA 2718(f)), or an 'ambulatory surgical center' (under SSA 1834(bb)).
Section 3(7)(A) (SSA 1846(c)(7)(A)) for labs; Section 4(1) (SSA 1899D(b)(1)) for imaging
Why it matters:This is a practical legislative measure to prevent redundant reporting requirements for integrated healthcare systems. It ensures that a service is only subject to one set of transparency rules, avoiding unnecessary administrative burden.
Case for: This prevents duplicative compliance efforts for healthcare entities that are part of larger systems already mandated to disclose prices. It streamlines the regulatory process and reduces unnecessary administrative costs for integrated providers.
Case against: No specific opposition to this provision, as it serves a practical purpose of avoiding redundant regulation and burden.
Estimated impact: Reduces administrative burden for integrated healthcare systems by ensuring that a single transparency mandate covers services provided by affiliated laboratories and imaging centers, rather than requiring separate disclosures.