Nov 09, 2022
The Transparency in Coverage rule requires health plans to share health care costs for members to make informed decisions on how they receive care. There are two main phases of the rule.
The first phase went live July 1, 2022, and it requires health plans to publish “machine-readable files” on their websites. Our machine-readable files are published here in JSON format as required by the rule. JSON files are intended for researchers and application developers — not the general public — and are not easily accessible without special software.
The second phase will go live Jan. 1, 2023. For this phase, we're developing a self-service price tool on our Sharp Connect member portal. It will allow members to look up a service and provider, then get an out-of-pocket estimate based on their plan. We’ll share details as we get closer to launching the new tool.
Prescription Drug Reporting
The TiC rule originally included a provision requiring plans and issuers to publish machine-readable files for prescription drug pricing. However, HHS announced that they would defer enforcement of this requirement pending further rulemaking.
Plans and issuers are still required to comply with certain reporting requirements related to Pharmacy Benefits and Drug Costs, which were outlined in a separate piece of legislation, the Consolidated Appropriations Act (CAA). Sharp Health Plan is working with our Pharmacy Benefit Manager (CVS Caremark) to begin reporting all required information to the federal government by the December 27, 2022 deadline.
Sharp Health Plan will submit the summary report and data for all fully insured groups.
