Transparency in Coverage Rule

Overview

On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to create a member-facing price comparison tool and post publicly available machine-readable files.   

The machine-readable files include negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Please see below for additional details and applicable links.

Consumer Price Transparency Tool

• Insurers and plans are required to create online consumer tools that include personalized information regarding members’ cost-sharing responsibilities for covered items and services, including prescription drugs.
• Cigna’s cost estimator tool can be found at www.myCigna.com.
• CVS/Caremark’s cost estimator tool can be found at www.caremark.com, then by navigating to “Check Drug Costs”.

Publicly Available Machine-Readable Files

• Insurers and plans are required to make available to the public machine-readable files disclosing detailed information on the costs of covered items and services including prescription drug pricing.
• Cigna has complied with this requirement and these files are available by following this link: https://www.cigna.com/legal/compliance/machine-readable-files