Price transparency has been one of President Trump’s most important health policy priorities. Transparency targets a key missing component of American health care: patients rarely know the price of their care before receiving it, and employers rarely know the price of services before paying for them. Without upfront price information, they often do not consider their options. Across both Trump administrations, the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), the Department of Labor (DOL), and the Department of the Treasury have pushed to make hospitals, insurers, and drug companies disclose real prices so patients can shop, employers can demand better value, and competitors must compete on price. Together, these behavior changes would place downward pressure on health care costs.
The administration has already taken important steps to strengthen these rules and promote transparency across the health care system. Price transparency is an overwhelmingly bipartisan priority, demonstrated by House passage (320 to 71) of the Lower Costs More Transparency Act in the 118th Congress. Done right, price transparency is not just a consumer protection measure, but a critical foundation for a functioning health care market. Below, we summarize major executive and administrative actions taken by the Trump administration to advance health care price transparency.
Trump’s Calls for Action This Term
In February 2025, President Trump issued Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” The order directed the Treasury, Labor, and HHS secretaries to rapidly implement and enforce price transparency rules—requiring disclosure of actual prices rather than estimates, ensuring pricing information is standardized and comparable across hospitals and health plans, and tightening compliance with reporting policies. This order spurred a wave of agency action on hospital and health plan price transparency.
In April 2025, President Trump issued Executive Order 14273, “Lowering Drug Prices by Once Again Putting Americans First.” This order directed the Secretary of Labor to propose regulations improving employer health plan fiduciary transparency into pharmacy benefit manager (PBM) compensation. EO 14273 has driven action on drug price transparency relating to PBMs and complements PBM transparency provisions passed by Congress in the 2026 extenders package.
In January 2026, President Trump called on Congress to maximize price transparency as part of the Great Healthcare Plan. Specifically, the Great Healthcare Plan would require any health care provider or insurer that accepts Medicare or Medicaid to prominently disclose prices and fees in their place of business.
Hospital Price Transparency
Hospital price transparency requirements were first established in a 2020 rule issued during President Trump’s first term. This rule required hospitals to publicly post the prices they charge for items and services in a machine-readable file that consumers, researchers, and employers could use to compare costs across hospitals.
The Biden Administration’s Failure to Enforce
Instead of enforcing the rule’s requirements, the Biden administration failed to meaningfully check hospital files for completeness, which allowed hospitals to get away with posting incomplete data, often padded with placeholders that rendered the files functionally unusable. A 2024 Government Accountability Office (GAO) review of CMS’s implementation of hospital price transparency requirements found that CMS checked only whether hospitals posted a file at all, not whether the data was sufficiently complete and accurate to be usable.
As part of this lack of oversight, the Biden administration allowed hospitals to enter a placeholder of “999999999” in the “estimated allowed amount” field whenever they said they lacked enough payment history to calculate a real number. This allowed many hospitals to “meet” transparency requirements without posting actual prices. CMS found hospitals used the placeholders much more frequently than expected: A February 2025 analysis of 68 large hospitals found that 63 percent used the placeholder at least once, and 38 percent used it for more than 90 percent of their entries.
The Trump Administration’s Recent Actions
In response to EO 14221, CMS has taken multiple steps to reverse course, tightening hospital price transparency requirements and enforcement so that pricing information is more meaningful for consumers and employers.
In May 2025, CMS issued a Request for Information (RFI) on how to improve its compliance and enforcement processes to ensure pricing information in machine-readable files is accurate and complete.
That same month, the agency also issued guidance clarifying what data hospitals must include in the machine-readable file. The guidance instructs hospitals to encode actual dollar amounts whenever a price can be calculated from a known case rate, fee schedule, or per diem. For prices set by formula—for example, when a hospital is paid as a percentage of a fee schedule—hospitals must calculate the average dollar amount they are paid for a service, known as the “estimated allowed amount,” using a year’s worth of payment records. The guidance also clarified that hospitals using the Biden administration’s placeholder workaround would no longer be in compliance with the law.
In November 2025, CMS finalized a rule that reinforced its May guidance to strengthen hospital price transparency. For formula-based pricing scenarios, the rule replaced the single “estimated allowed amount” figure with a range—the 10th percentile, median, and 90th percentile allowed amounts, plus the number of claims used to calculate these amounts. These requirements give consumers and researchers a clearer view of what insurers actually paid hospitals, since a single average can hide wide variation in payment amounts. The rule also strengthens accountability for data accuracy and violations, requiring hospitals to attest that their machine-readable file data is accurate and complete and to designate a CEO or senior executive as responsible for that accuracy. It also offers a 35 percent reduction in civil monetary penalties for hospitals that admit a violation and waive their right to a hearing, allowing CMS to resolve enforcement actions more efficiently. The rule took effect January 1, 2026, with enforcement beginning April 1, 2026.
Transparency in Coverage
The Departments of Labor, HHS, and Treasury have moved to strengthen transparency requirements for health plans, too. Like hospitals, health plans have been required since 2022 to publish their negotiated rates in machine-readable files under the 2020 Transparency in Coverage (TiC) final rule issued during the first Trump administration. But the files that plans have posted have been notoriously hard to use—often massive and lacking the context users need to make sense of the data.
In May 2025, the Departments released FAQs Part 70, announcing updated technical requirements aimed at making plan machine-readable files smaller, cleaner, and more usable—including by stripping out duplicate data, requiring clear provider network disclosure, and cutting unnecessary data fields. The Departments finalized these requirements in October 2025, and they took effect in February 2026.
In December 2025, the Departments issued the TiC proposed rule, a substantive update to the 2020 rule aimed at making the files dramatically smaller and more usable. The primary driver of large file sizes, the Departments found, was the inclusion of negotiated rates for services providers do not actually perform, such as cardiac surgery rates for podiatrists. The rule would require plans to exclude these implausible provider-rate combinations. It would also require them to publish one rate file per provider network, rather than one per plan—significantly reducing duplicate data because many plans share the same networks with the same rates. Additionally, the rule would add contextual data elements clarifying product type, enrollment count, and network name; publish a file showing what changed between reporting periods; and expand out-of-network data where many plans currently report little or nothing.
Together, the changes are designed to substantially reduce file sizes (by an estimated 70 percent) and dramatically increase the share of files with usable data. The rule, including the machine-readable file requirements, has not yet been finalized. If finalized as proposed, it would take effect 12 months after publication.
Drug Price Transparency
The administration has also targeted opaque prescription drug pricing. The health plan transparency requirements in the 2020 TiC final rule included a separate machine-readable file requirement for prescription drugs—covering both negotiated rates and historical prices. However, this requirement has never been actively enforced, and the guidance surrounding it has never been finalized. Additionally, plan sponsors often lack visibility into how PBMs are compensated. Together, this helped preserve an opaque drug-pricing environment in which key pricing information remains hidden from patients, employers, and plan sponsors. As a result, patients and other purchasers often cannot determine whether the price they are offered reflects a fair deal or whether a lower-cost, higher-value option is available.In May 2025, the Departments issued a RFI seeking public input on how to implement or revise the prescription drug machine-readable file requirement—seeking input on necessary data elements, file size and complexity, technical guidance, and potential modifications to improve accurate and timely reporting. The policy is intended to support clearer prescription drug price information, which could help consumers, employers, and third-party tools better compare coverage and drug costs.
In January 2026, following EO 14273, DOL proposed a rule that would require PBMs to give employers more information about how they are paid for managing prescription drug benefits. The proposal is intended to give employers more visibility into PBM fees and compensation when they contract for drug coverage, helping them design plans and pharmacy networks that maximize value. If finalized as proposed, the rule would apply to plan years beginning on or after July 1, 2026.
Congress has taken similar action on PBM transparency. The 2026 health extenders package, signed into law in February 2026, included provisions that would require increased transparency about the nature of rebates, discounts, fees, and other sources of revenue generated by PBMs in the conduct of their services.
In February 2026, the Federal Trade Commission (FTC) settled an insulin pricing case with Express Scripts, one of the nation’s largest PBMs. As part of the settlement, Express Scripts agreed to increase price transparency for plan sponsors by providing drug-level reporting, sharing data needed to comply with the TiC rule, and disclosing payments made to brokers who represent plan sponsors.
Conclusion
Health care remains unusual among major sectors of the American economy because prices are often hidden. The current health care system puts personal health care decisions in the hands of government payors, insurance companies, and employers—not employees or patients. As a result, consumers are often blind to actual prices, and providers and insurers have little incentive to make their rates transparent. However, some consumers are facing stronger price incentives, particularly given the rise of high-deductible plans, and more complete pricing information can help employers improve benefit design and monitor the performance of the insurers they hire as third-party administrators.
The Trump administration has taken several important steps towards true price transparency in health care, and it has room to go even further. Price transparency is most effective when consumers directly benefit from choosing lower-cost, higher-value care. CMS and Congress must give consumers more control over their health care dollars so they can take advantage of price information. They can do so by expanding access to Health Savings Accounts (HSAs) and Individual Coverage Health Reimbursement Arrangements (ICHRAs).
Combined with stronger compliance and enforcement, these reforms would make health care pricing substantially more visible and actionable for patients, employers, and policymakers. More empowered consumers and employers who shop for the best value will help drive down costs across the entire health care sector.
