Lower Costs, More Transparency Act of 2026

Key Points

• Starting January 1, 2028, all hospitals must publicly post their actual prices online for free, including the rates they negotiate with each insurance company, discounted cash prices, and gross charges for every item and service they provide.
• Health plans and insurers must give members a real-time online tool showing their estimated out-of-pocket costs for specific services, including how much of their deductible they have used and any prior authorization requirements.
• The bill shines a light on pharmacy middlemen by requiring pharmacy benefit managers (PBMs) to disclose "spread pricing" -- the gap between what they charge the health plan for a drug and what they actually pay the pharmacy.
• Clinical labs and imaging centers must also post their prices online for common shoppable services. Labs face fines of up to $300 per day for noncompliance, while imaging providers face similar penalties with some flexibility for rural areas.
• Hospitals that knowingly and willfully refuse to post their prices face escalating fines, with the largest hospitals (500+ beds) facing penalties of up to $10 million on top of daily per-bed fines. Rural and underserved hospitals can receive penalty waivers if compliance would threaten patient access.