Oh Oh, No More Secret PPO & PBM Contracts

Managed Care Rep. Reacts

Most group plans will be required to provide members (1) In-network provider rates for all covered items and services (2) Out-of-network allowed amounts and billed charges for all items and services and (3) Negotiated rates and historical net prices for covered prescription drugs.

Group Health Plan Transparency Disclosure Rules Finalized: What Plan Sponsors Should Know

“[E]ach plan sponsor should … confirm that the insurer/TPA is preparing to make the machine-readable files publicly available … [A] self-funded plan is responsible if the TPA fails to comply, so the plan sponsor should consider whether other protections are appropriate, such as a specific indemnification from the TPA.”  MORE >>

Dickinson Wright PLLC

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