Cheat Sheet

The Transparency in Coverage Rule

    Key Takeaways
    • On October 29, 2020, CMS finalized its transparency rule for payers, expanding on its push toward increased competition and consumerism across the health care industry in the hopes of driving down costs.
    • Payers are required to publish negotiated rates with providers and pharmacies and out-of-network charges by January 1, 2022, and create an online cost-sharing estimation tool for members by January 1, 2023.
    • Payers should expect that the rule will have implications regarding rate negotiations, payer-consumer relations, and market disruption from newly available information.

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