President Trump’s February 25, 2025, Executive Order calls for the rapid implementation and enforcement of existing healthcare price transparency regulations by the Departments of the Health and Human Services, Labor, and Treasury. It addresses enforcement of prior rules issued under the first Trump Administration that required hospitals to publicly post prices and health plans to publicly post negotiated rates. The Executive Order calls for the identification of opportunities to further empower consumers with meaningful price information, opening the door for new policy. Timely, accurate, and understandable pricing data can enable consumers to become savvier purchasers of healthcare services and are fundamental to helping employers evaluate the cost and quality of healthcare services.  

The Peterson Center on Healthcare applauds the President’s Executive Order and offers the following recommendations to: 

• Improve Hospital Price Transparency and Transparency in Coverage data and compliance; 

• Strengthen employers’ access to claims data, building on the gag clause prohibition in the 2021 Consolidated Appropriations Act (CAA); and 

• Use pricing and quality transparency to promote competition, consumer choice, and efficiency. 

Actions to Improve Hospital and Payer Price Transparency  

Standardize How Hospital and Payer Data Are Shared: 

• Develop standard data schema for payers releasing healthcare pricing data.  Data should be released in relational files, instead of JSON format, to make it more usable and eliminate the hundreds of thousands of reference files currently required. 

• Compel payers and providers releasing pricing data to submit the hosting location to CMS, and CMS should release a consolidated list of hosting locations available to the public.  

• Require reporting organizations to post plain language instruction manuals and contact information for people or departments who can answer questions about data. 

Enhance Hospital and Payer Data: 

• Implement the payer machine readable file requirements for prescription drug pricing to facilitate better drug purchasing. The data should include prices, rebates, indirect remuneration, restocking fees, dispensing fees and all other important channel financial information that impact costs and pricing.  

• Direct providers and payers to report the volume of services delivered and paid for. Currently, an estimated 96.5% of prices in payer datasets are ghost codes, i.e. prices for services that providers never perform. Reporting volumes would help eliminate ghost codes, making data easier to use. 

• Ensure datasets include negotiated rates, average paid amounts, and cash prices. Paid amounts vary based on factors such as contractual allowances, discounts, and reimbursement ceilings. Including average paid amounts alongside negotiated rates would provide a more accurate picture of spending. 

• Link price data to standardized plan information such as plan name, benefit design, co-pays, and deductibles. This information is already required for plans sold on Marketplaces.  

• Data is currently reported using NPIs and TINs, which must be painstakingly linked to other information to identify providers and sites of care. Requiring that datasets link TINs or NPIs to basic information such as provider names and addresses would simplify data use.  

Expand the Entities that Must Report Price Data:  

• Require all health plans to report price data, including Medicare Advantage, traditional Medicare, Medicare Part D, Managed Medicaid, Tri-Care, and retiree plans. Currently only commercial plans are required to report. 

• Expand price transparency requirements to ambulatory surgery centers (ASCs), imaging centers, and labs. Expansion to additional providers may also be justified based on their contributions to healthcare costs and the ability of patients and employers to shop for the best value.

Increase Compliance: 

• Encourage payer compliance by requiring executives at reporting organizations to attest to their organizations’ compliance and by publicly reporting enforcement actions. 

• Increase enforcement activity and penalties, which could include moving quickly towards enforcement actions in lieu of multiple warning letters; increasing civil and monetary penalties; and proposing escalating penalties for persistent noncompliance. 

Strengthen Employers’ Access to Their Claims Data 

• Guarantee unfettered claims data access to better enable employers to understand and reduce healthcare costs. To date, the CAA’s gag clause prohibition has failed to provide employers with access to their claims data. The Administration could elevate the gag clause prohibition FAQs into regulation, which could include formalizing a process for employers to submit complaints about TPAs and PBMs that fail to comply with the gag clause prohibitions.  

• Require TPAs and PBMs to attest compliance with the CAA gag clause prohibition. 

• Compel PBMs to share drug prices and rebate values with employers at the employer level, not just the plan level. 

• Facilitate data use among purchasers through administrative safe harbors to protect employers from anti-trust/collusion risk related to data sharing and analysis.  

Use Transparency to Encourage Competition and Consumer Choice 

• Implement and enforce the rules around hospital and payer consumer-facing price tools, including the Advanced Explanation of Benefits provisions of the No Surprises Act to help consumers understand price implications of their provider selection decisions prior to receiving care.  

• Require hospitals to post the data that feeds into Hospital Compare and the CMS’ quality payment program (QPP) to enable employers and consumers to consider both price and quality information.  

Learn more about how the Center is working to create a more competitive and effective healthcare system by improving access to data and information for healthcare providers, payers, policymakers, and regulators.