What Is the Lower Costs, More Transparency Act?

The Lower Costs, More Transparency Act is a bipartisan bill designed to expand pricing visibility across the healthcare system and improve access to cost information for patients, providers, employers, and payers. As healthcare costs continue to rise and administrative requirements become more complex, this legislation reflects a growing national focus on transparency, accountability, and more predictable care.

Although it’s still moving through the legislative process, the Act outlines several key provisions that could influence how organizations share pricing information, manage pharmacy benefit practices, and approach reimbursement, particularly under Medicare.

Why Healthcare Pricing Transparency Matters

Uncertain healthcare pricing has long been one of the biggest challenges for patients and providers alike. Today, many individuals do not have access to cost information before receiving care. Similarly, health plans and employers often struggle to understand the drivers of spending behind medical services and prescriptions.

The Lower Costs, More Transparency Act aims to address these challenges by ensuring that clearer, more actionable information is available across the healthcare ecosystem. This aligns with ongoing national efforts to improve financial clarity, strengthen trust, and increase patient access to essential services.

Key Provisions of the Lower Costs, More Transparency Act

1. Expanded Price Transparency for Providers

The Act would require hospitals, laboratories, imaging centers, and ambulatory surgery centers to publish their pricing information, including negotiated rates and cash prices.

These requirements build on existing federal transparency rules but introduce stronger reporting standards and enforcement. The goal is to help patients better understand their financial responsibility and support more informed decision-making before care is delivered.

2. Greater Clarity into PBM Practices

Pharmacy benefit managers (PBMs) play an important role in drug pricing and formulary design, yet their operations are often difficult to follow. The Act would require PBMs to regularly disclose:

• Rebates and fees
• Prescription drug spending
• Any cost savings passed to health plans

Additionally, the legislation would prohibit practices like “spread pricing.” Spread pricing is a reimbursement practice that is most often used by pharmacy benefit managers (PBMs) where the PBM bills a health plan or employer more for a medication than it reimburses the pharmacy. The PBM keeps the difference, or “spread,” which can obscure true drug costs and contribute to higher overall healthcare spending.

In Medicaid, the Act would ensure a clear link between what states pay and what pharmacies receive. These measures are intended to support more predictable drug costs and improve transparency for plan sponsors.

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3. Site-Neutral Payment Standards

Under current Medicare policy, reimbursement rates may differ depending on whether a service is performed in a physician office or a hospital outpatient department. The Act proposes site-neutral payments for certain drug administration services, meaning Medicare would reimburse the same amount regardless of setting.

This provision is designed to create greater cost alignment across care delivery settings. While it may reduce Medicare spending, it has received mixed feedback from hospitals that rely on current payment structures.

4. Continued Support for Essential Health Programs

The bill also renews or extends funding for programs that support healthcare access nationwide, including:

• Community Health Centers
• The National Health Service Corps
• Primary care and graduate medical education programs

These investments help ensure that patients can continue to access high-quality care.

5. Stronger Enforcement and Oversight

To support compliance, the Act allocates funding to federal agencies responsible for monitoring price transparency and PBM reporting. Organizations that fail to meet requirements may face additional penalties or corrective action.

This emphasis on enforcement highlights a broader shift toward financial clarity and accountability across healthcare.

READ MORE: careviso’s seeQer Platform Supports Healthcare Price Transparency Following Executive Order

What the Lower Costs, More Transparency Act Could Mean For the Industry

If fully enacted, the Lower Costs, More Transparency Act could influence multiple areas of healthcare operations:

• Patients may gain higher visibility into treatment costs.
• Employers and plan sponsors could better understand spending patterns and negotiate effectively.
• Providers may see increased expectations around data reporting and pricing accuracy.

Overall, the Act reinforces a nationwide movement toward improving financial transparency and simplifying the patient experience. These goals align closely with ongoing federal policy trends.

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Operational Impact on Providers and Payers  

The Lower Costs, More Transparency Act is expected to influence day-to-day operations across healthcare organizations, especially within revenue cycle workflows and contract management.

As the Act increases expectations for real-time pricing, clear cost disclosures, and accurate data, administrative teams will face added pressure to deliver precise information quickly. These requirements are important for improving transparency and patient trust, but they can also heighten operational strain and contribute to burnout if teams continue relying on manual processes or disconnected data sources.

This shift highlights the need for technology that supports price transparency at every stage of the workflow. seeQer is already built with these needs in mind, giving providers and payers the ability to present patient costs before care, monitor compliance through integrated dashboards and analytics, and work from continuously updated data pulled from verified external sources rather than manually maintained spreadsheets or siloed systems.

By automating key parts of compliance and embedding accurate information directly into existing workflows, seeQer helps organizations stay aligned with the Act’s requirements while reducing administrative burden and improving overall efficiency.

Looking Ahead

While the Lower Costs, More Transparency Act has not yet become law, it represents a significant step toward reshaping how healthcare organizations report prices, manage reimbursement, and communicate financial information to patients. As policymakers continue to evaluate these measures, Increased transparency requirements could have a significant impact on how providers, payers, and health systems operate in the future.

The Act underscores a simple but powerful expectation: patients deserve clear, accurate, and accessible cost information before they receive care. This principle remains central to ongoing efforts to build a more navigable and equitable healthcare system. As organizations look ahead, preparing means evaluating current workflows, identifying where manual processes create delays or inaccuracies, and ensuring that cost data is consistent across teams.

This is where seeQer can offer meaningful support. By consolidating price transparency tools, presenting patient costs upfront, and supplying reliable data within everyday workflows, seeQer helps providers and payers stay ahead of compliance requirements while strengthening the overall patient experience.