On February 25, 2025, President Donald Trump announced further actions to promote healthcare price transparency through an executive order. The new order builds upon a 2019 executive order during Trump’s first term, which led to the current state of price transparency. It will have significant implications for not only hospitals and health plans, but also pharmacy benefit managers (PBMs), over the next 90 days and beyond.
How Will the New Executive Order Affect Hospital Price Transparency?
Over the next 90 days, hospitals should expect an increase in CMS audits that include enforcement for noncompliance. In Trump’s address, he stated, “Hospitals and health plans were not adequately held to account when their price transparency data was incomplete or not even posted at all.”1 Trump also noted that while the previous administration increased audits and enforcement efforts for noncompliance, more can be done.
Other changes expected over the next 90 days will include required disclosures of actual prices in lieu of the estimated amount for reimbursement, as well as standardization of price information across hospitals. The timing and details of these new requirements are currently unclear, but it is fair to assume that major changes will develop, and our current regulations will evolve.
How Will the New Executive Order Affect Health Plans?
The order mentions additional audits and enforcement for both hospitals and health plans, and it will also require health plans to post their Medicare Part D plans related to their PBM. As of this time, there have been little to no audits or enforcement for payors because health plans are audited at the state level, whereas hospitals are audited at the federal level. It is currently unclear how the administration plans to work with states to support increased audits and penalties for health plans.
How Price Transparency Could Evolve to Other Types of Healthcare Organizations
With price transparency continuing to evolve, we will likely see further changes to the regulations over the next five to 10 years. For example, there may be changes to the consumer-friendly requirements on the hospital side, or machine-readable file requirements for ambulatory surgery centers, imaging clinics, laboratories, and other types of organizations. As momentum continues to build behind price transparency and its benefits for patients, healthcare organizations need to keep an open mind to move forward and grow with the requirements.
How Forvis Mazars Can Help
Price transparency is here to stay. Organizations that have a plan to proactively navigate the requirements can not only improve patient experiences but also strengthen their organization’s performance. At Forvis Mazars, we help organizations pursue regulatory excellence through compliance with price transparency requirements, as well as support financial discipline by using available price transparency data to help develop pricing strategy and negotiate contracts and reimbursement between hospitals and payors.
If you have questions about the new price transparency requirements and what they mean for your organization, please reach out to one of our professionals.
- 1“Trump Issues Executive Order Reinforcing Hospital Price Transparency Rule From First Term,” thehill.com, February 26, 2025.