Health Data Access, Transparency, and Affordability Act of 2026

Key Points

• The bill requires that contracts between employer health plans and service providers (insurers, pharmacy benefit managers, third-party administrators) give plan fiduciaries full access to all claims and encounter data, pricing formulas, payment amounts, and contract terms. This removes the ability of middlemen to hide how employer healthcare dollars are spent.
• The bill bans so-called "gag clauses" in contracts that restrict employers from seeing the true costs of their health plans. Any existing contract provisions that block data access are declared void as against public policy.
• Employers gain the right to choose their own auditors and set audit scope and frequency, and to flag potentially erroneous or fraudulent claims for action. Service providers must also give employers access to overpayment recovery terms.
• Service providers that violate these data access requirements face civil penalties of up to $10,000 per day. The bill also bars those providers from being indemnified or relieved of liability for these penalties through contract provisions.
• All claims data must be provided to employers in standardized electronic formats (ASC X12N 837, X12N 835, and NCPDP for pharmacy claims) at no cost. Non-claim costs must be available in real time through a web portal and API.

Votes

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Related Bills

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