And in 2024, we will likely see increased enforcement and litigation under 2020 Transparency in Coverage (TiC) rules and the Consolidated Appropriations Act of 2021, which together significantly altered payors’ disclosure obligations, a process that is being furthered by legislation pending since the end of 2023.

Federal requirements aimed at increasing health care cost transparency continue to vex payors. First, payors may come under scrutiny and may experience ramped-up enforcement if they lag behind in complying with complicated MRF requirements. Although MRFs containing contracted rates and out-of-network allowed amounts for medical services have been required since July 1, 2022, strict compliance with the regulations has been challenging, particularly for payors with unique contracting arrangements. Application to downstream contracts, such as those accessed through vendors or independent physician associations (IPAs), is also uncertain and may be operationally difficult to implement.

Regulators recently announced that the MRF requirements apply to prescription drug prices. Previously, application to prescription drugs had been deferred. This may cause payors to scramble to uphold their own compliance and enforce it on their pharmacy benefit managers as soon as possible.

So, although enforcement of MRF requirements has been minimal to nonexistent so far, we may see increased attention from regulators as we enter the third year of MRF requirements being in effect.

Second, in 2024, payors must now offer members an online cost-sharing lookup tool for all covered items and services. The TiC regulations first required payors to provide this lookup tool in 2023, but only for 500 identified items and services. Operational challenges plagued even this limited rollout, and many plans continued to adjust their lookup tool for regulatory compliance throughout the first year. Increasing its scope to all covered services will amplify compliance risks around compliant disclosures, non-traditional contracting arrangements or benefit structures, and application to downstream contracted rates through vendors and IPAs. If TiC compliance (including the MRF requirements noted above) ramps up in 2024, the member cost-sharing tool may come under regulatory scrutiny. Further, H.R. 5378, a federal bill pending since the end of 2023, would codify both the MRF and member cost-sharing tool requirements of the TiC regulations into federal statutes beginning in 2026.