Sponsor
Jason Smith
Representative · R-MO
Official title: To promote health care price transparency, and for other purposes.
Introduced July 13, 2026 by Jason Smith · Last progress July 13, 2026
Representative · R-MO
The bill greatly expands consumer price transparency, plain‑language tools, and regulatory oversight to help patients compare costs and expose drug/PBM pricing practices, but it does so at the cost of substantial compliance burdens, privacy/commercial‑data risks, potential strain on small and rural providers, and uncertain effects on market bargaining and prices.
Patients (Medicare, Medicaid, uninsured, and private plan enrollees) gain standardized, item‑level and real‑time price and out‑of‑pocket estimates across hospitals, ASCs, pharmacies, and plans, making it easier to compare costs and plan care.
People with limited English proficiency, disabilities, or limited tech access get plain‑language, no‑cost tools and telephone support so posted prices and estimator outputs are more accessible and usable.
Standardized, machine‑readable data, APIs, and public facility submissions enable third‑party developers, researchers, and regulators to build comparison tools, run analyses, and monitor pricing trends.
Hospitals, ASCs, insurers, PBMs, pharmacies, and plans must incur substantial administrative and technical compliance costs to collect, standardize, validate, and publish detailed price and claim data and build estimator/APIs—costs that may be passed to patients through higher prices or premiums and that may divert staff from patient care.
Public release of payer‑specific negotiated rates, per‑claim data, and detailed transactional datasets risks exposing proprietary commercial information and, if deidentification fails or datasets are combined, patient privacy—leading to litigation, competitive harm, or data‑security incidents.
Civil monetary penalties and frequent attestations for noncompliance could financially strain small or rural hospitals, ASCs, and safety‑net providers—potentially threatening local access to care, especially where waivers are limited.
Based on analysis of 8 sections of legislative text.
Mandates standardized public and machine-readable hospital, plan, and PBM price disclosures, consumer cost tools, pharmacy gag-clause bans, MA/Part D reporting, and agency enforcement funding.
Requires hospitals, ambulatory surgical centers, group health plans, issuers, PBMs, Medicare Advantage organizations, and Part D sponsors to disclose detailed price and payment data in standardized formats and to make consumer-facing cost tools available. Sets compliance deadlines (with major hospital rules effective January 1, 2027 and plan-level consumer tools and reporting effective January 1, 2029), civil monetary penalties for noncompliance, technical-assistance and accessibility requirements, and new reporting and auditing obligations for vertically integrated Medicare Advantage/Part D organizations. Provides funding for implementation and enforcement, directs Treasury/HHS/DOL to issue technical standards and APIs, creates parallel prohibitions preventing plans/PBMs from barring pharmacies from informing patients about lower out-of-pocket cash prices, and requires standardized public disclosures of negotiated rates, payer-specific charges, and price-comparison tools for enrollees and consumers.