The federal government will delay for six months its enforcement of key portions of the Transparency in Coverage (TiC) final rule that goes into effect on January 1, 2022. The change was announced in guidance issued jointly by the U.S. Departments of Labor, Health and Human Services, and the Treasury on August 20.
The TiC rule requires insurers and health plans to disclose, in separate machine-readable files, (i) in-network provider rates for covered items and services, (ii) out-of-network allowed amounts and billed charges for all covered items and services, and (iii) negotiated rates and historical net prices for covered prescription drugs. The guidance acknowledged the “considerable time and effort required to make the machine-readable files available,” and delaying enforcement will give plans more time to comply. For plan years beginning on or after July 1, 2022, insurers will be required to post the files in the month in which the plan year begins.
The TiC rule has been challenged in court in two separate lawsuits. The suit by the U.S. Chamber of Commerce claims that requiring insurers to reveal confidential information to competitors could increase costs to consumers, and the Pharmaceutical Care Management Association (which represents pharmacy benefit managers) claims that compliance with the rule will be costly for insurers and PBMs and confuse consumers.
The guidance covered numerous other topics, including certain Affordable Care Act requirements and certain pharmacy benefit and drug cost reporting requirements for which implementing regulations have not yet been issued. Enforcement of the latter will be delayed for one year, until December 27, 2022.