# Health Care Price Transparency Act of 2023
This bill requires hospitals, ambulatory surgical centers, imaging providers, and clinical laboratories to publicly disclose their prices for medical services starting in 2025-2028. Hospitals must list standard charges and prices for at least 300 "shoppable services" (procedures that can be scheduled in advance) in consumer-friendly formats, either through detailed price lists or online price estimation tools. Ambulatory surgical centers face similar requirements beginning in 2028. Imaging and laboratory providers must post prices for shoppable services starting in 2025.
For private insurance plans, the bill requires health insurance companies and group health plans to provide patients with real-time cost estimates showing what they would pay out-of-pocket for specific services at specific providers. Plans must also publicly release detailed pricing data three times annually in machine-readable formats so consumers can compare costs across providers and plans. These requirements take effect two years after enactment.
The bill establishes oversight of pharmacy benefit managers that manage prescription drug coverage, requiring them to submit detailed annual reports to health plans about drug spending, manufacturer rebates, and copayment assistance programs. It also caps patient cost-sharing for prescription drugs in Medicare Part D at the drug's net price (the price after manufacturer rebates are deducted).
The bill funds implementation with $10 million in 2024 and creates penalties of up to $2 million annually for hospitals that fail to comply with transparency requirements, with higher penalties for repeat violations. The bill requires government agencies to study healthcare price transparency tools and make recommendations for improvement, and directs Medicare to monitor vertical integration in the healthcare industry where insurers or pharmacy benefit managers own healthcare providers or pharmacies.
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