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September 02, 2021

Federal Agencies Announce Price Transparency Enforcement Discretion for Health Plans

As reported last week, HHS, Labor, and Treasury (the “Departments”) issued a set of FAQs regarding the implementation of certain provisions of the Affordable Care Act and certain titles of the 2021 Consolidated Appropriations Act. Importantly, the FAQs provide that the Departments are exercising enforcement discretion with regard to certain health plan price transparency requirements found in the Transparency in Coverage Final Rule and the No Surprises Act. Such enforcement discretion includes not requiring health plans to: (1) publish a machine-readable file for covered prescription drugs pending future rulemaking; (2) publish a machine-readable file for in-network negotiated rates and out-of network allowed amounts and billed charges until July 1, 2022, (3) create a member-facing price comparison tool until January 1, 2023; (4) provide members with an advanced explanation of benefits pending future rulemaking; and (5) report certain pharmacy benefit and drug cost information until December 27, 2022.