CMS Moves TIC Reporting to Quarterly, Sets Drug File Timeline

Insurers will have to post price transparency files quarterly instead of monthly under finalized updates to the Transparency in Coverage (TIC) rules announced by CMS that build on price transparency initiatives from President Donald Trump's first term.¹

The announcement stems from the executive order (EO) titled Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information, which President Trump signed in February 2025, directing federal agencies to implement and enforce stronger price transparency requirements for payers and providers.² The EO served as an extension of a previous EO signed during his first term in 2019 to continue pursuing health care price transparency.²

“Americans should know what their healthcare will cost before they receive it,” HHS Secretary Robert F. Kennedy Jr. said in a press release.¹ “…These rules give patients clearer, more reliable information to compare costs, understand their coverage, and make informed decisions before they receive care.”

TIC rules, in effect as of 2022, followed the Hospital Price Transparency rule, which required hospitals to post a machine-readable file (MRF) that contains prices for select shoppable services.³ TIC built on the hospital rule, further requiring commercial insurers to disclose negotiated rates for all providers and to update them monthly.³ Under the final rules, plans and issuers will update their in-network rate and out-of-network allowed amount files quarterly instead of monthly, which CMS said will lower administrative burden.¹ Many commercial insurers' TIC files contained ghost rates—negotiated rates for procedures a provider wouldn't perform—and duplicative information.^1,4 These made the files difficult to analyze for consumers, health care analysts, researchers, and policy makers.^3,4

Ghost Rates and Missing Inpatient Data Limit TIC File Usability

David Muhlestein, PhD, JD, founder and CEO of Simple Healthcare, told The American Journal of Managed Care^® (AJMC^®) in a January 2026 episode of the Managed Care Cast podcast that more than 90% of TIC data are ghost rates, such as a psychiatrist with a negotiated rate for heart surgery.⁴

A separate analysis of Aetna, Cigna, and UnitedHealthcare's 2025 TIC files, authored by Muhlestein and Yash Pathak and published in December 2025, found that physician and hospital outpatient data were generally more complete, while inpatient data were often sparse.³

Ghost rates increase the size of TIC files, making them harder to evaluate, and the new regulations aim to reduce duplicative and unnecessary information in the files.⁴ Trump's EO also cited an analysis from 2023 that projected as much as $80 billion in health care savings for consumers, employers, and insurers by 2025 if the 2020 regulations were fully implemented.²

What TIC Updates Mean for Employer Savings and Drug Price Data

Muhlestein described the benefit for employers, specifically, of using TIC data to choose the lowest-cost network in their market and to steer employees toward lower-cost providers.⁴

“If you could both choose the lower network, the lower-cost network, within your market, and direct people to the more efficient, lower-cost providers, there is a 30-plus percent potential savings that employers could see. That is incredible,” he explained.

The departments of HHS, Labor, and the Treasury plan to begin developing the schema, or required data structure, for the Prescription Drug File in November 2026 and to finalize it around May 2027.¹ The file was required under the 2020 rules but has not been consistently enforced and is meant to disclose in-network rates and historical net prices for covered drugs. Plans and issuers will then be expected to publish their Prescription Drug Files using this schema starting in December 2027 and monthly thereafter.¹

“We want to have people that are competing in cost and quality.… It's problematic when people don't know what the cost is and they don't know what the quality is,” Muhlestein said in his interview with AJMC about his research on gaps in TIC data.⁴ “And price transparency is a big step along that way to help us understand what the price is so that people can start to compete based on price.”

References

1. New regulations make it easier to find, compare, and report healthcare pricing and coverage information. News release. CMS. October 5, 2026. Accessed October 6, 2026. https://www.cms.gov/newsroom/press-releases/new-regulations-make-it-easier-find-compare-report-healthcare-pricing-coverage-information

2. Making America healthy again by empowering patients with clear, accurate, and actionable healthcare pricing information. The White House. February 25, 2025. Accessed October 6, 2026. https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/

3. Muhlestein DB, Pathak Y. Price transparency with gaps: assessing the completeness of payer Transparency in Coverage data. Am J Manag Care. 2025;31(Spec. No. 15):SP1121-SP1127. doi:10.37765/ajmc.2025.89862

4. McCrear S, Muhlestein DB. Transparency in Coverage data to expose ghost rates and hold payers accountable: David Muhlestein, PhD. AJMC. January 20, 2026. Accessed October 6, 2026. https://www.ajmc.com/view/transparency-in-coverage-data-to-expose-ghost-rates-and-hold-payers-accountable-david-muhlestein-phd