CMS Set December 2027 for Insurers’ Prescription Drug Price Files, a Requirement on Hold Since 2021
The Centers for Medicare & Medicaid Services finalised changes to the Transparency in Coverage rules with the Departments of Labor and the Treasury on 5 October. Insurers and group health plans will publish in-network rates once per provider network rather than per plan, update pricing files quarterly instead of monthly, report more out-of-network allowed amounts, and name a chief executive or senior official who attests to the data. Cost-sharing estimates must also be given by phone on request. The prescription drug file, required since the 2020 rules, now has a timetable, with schema work starting in November. The rules take effect in 2027 December.
The drug file is what reaches manufacturers. CMS’s fact sheet describes it as disclosing in-network rates and historical net prices for covered drugs, a requirement that has waited on rulemaking since enforcement was deferred in 2021. The schema, due around May 2027, will decide how much of that net price becomes public.
- Brand manufacturers and PBMs: historical net price is where rebates show. If the schema keeps that element at plan level, net prices for rebated brands become public files that competitors, employers and state regulators can read. Contracting teams should model which rebate terms a plan-level net price would expose before the schema work closes.
- Plans and providers: CMS compliance is now the floor. The same day, FTC Chairman Andrew Ferguson, quoted in CMS’s release, sent warning letters telling large healthcare services companies that CMS rules give no safe harbour under the FTC Act. Data attested by a named executive is easier to hold against anyone who publishes a misleading price.
- Signposts: November, May and the first drug files. Watch who CMS brings into the drug file schema work in November, whether the schema finalised around May 2027 keeps historical net price, and what the first monthly drug files show.
Read the original source (CMS) →
Read the CMS fact sheet (CMS-9882-F) →