On November 12, 2025, the longest government shutdown in U.S. history finally ended. During the shutdown, executive agency activity slowed, or ceased, impacting employers in a variety of ways. From an employee benefits perspective, the release resulted in a delay of agency guidance, including important healthcare transparency rules.
However, transparency, particularly regarding prescription drug coverage, remains a priority of the Trump administration. Accordingly, now that government operations have resumed, employers should anticipate the release of significant transparency guidance in the coming days and should understand the potential impact on their prescription drug plans.
Price Transparency Rules
First, employers should expect the issuance of proposed price transparency rules, which will likely include provisions to implement the prescription drug machine-readable file (MRF) requirement under the Transparency in Coverage final rule (TiC rule).
As background, in February, President Trump signed an executive order that directed the DOL, HHS, and IRS (the departments) to fully implement and enforce existing price transparency rules, including the TiC rule. Subsequently, the departments issued a request for information to gather stakeholder views on achieving the order’s objectives. Please see our March 4, 2025, article on Executive Order 14221 and May 28, 2025, healthcare transparency update.
The TiC rule requires nongrandfathered group health plans and insurers to publicly post monthly MRFs of their in-network (INN) negotiated rates, historical out-of-network (OON) allowed amounts and charges, and prescription drug INN rates and historical net prices. The MRFs can then be accessed by data analytics firms who compile, analyze, and reorganize the pricing data into tools that employers can use to comparison shop for healthcare coverage.
As recognized by the order, the TiC rule has yet to be fully enforced. Notably, the departments have never implemented the prescription drug MRF requirement, largely due to litigation seeking to block it from taking effect. Additionally, although plans and insurers have been posting MRFs of INN and OON medical prices since 2022, the reported data is not always accurate, complete, or consistent. The proposed rules are expected to address these deficiencies and perhaps establish a timeline for implementing the prescription drug MRF requirement.
Service Provider Compensation Disclosure Regulations
Next, employers should anticipate the release of proposed rules to implement the CAA 2021 service provider compensation disclosure requirements, particularly with respect to PBMs.
In April, the president signed another executive order, which was specifically aimed at lowering prescription drug prices and increasing transparency and competition in drug markets. Among other items, the order directed the DOL to propose regulations pursuant to ERISA § 408(b)(2) to help employers better understand compensation received by their PBMs. Please see our April 22, 2025, article on Executive Order 14273.
Under the CAA 2021, service providers that expect to receive $1,000 or more in connection with brokerage or consulting services to an ERISA group health plan must provide a written compensation disclosure to the employer/plan fiduciary before entering a contract with the plan. The disclosure is designed to help the employer fulfill their fiduciary obligation to prudently select service providers and determine if their compensation is reasonable.
To date, no formal guidance has been issued to implement these disclosure requirements, despite the complexity of certain compensation structures, particularly with respect to PBMs. Thus, questions have arisen regarding whether employers are receiving the complete and clear information needed to assess service provider compensation. The proposed regulations are expected to address these concerns regarding the disclosures provided by PBMs, and perhaps other service providers.
Employer Takeaway
Employers should expect a flurry of proposed transparency rules and regulations in the near future. Although the above is intended to provide a general overview of what is likely to come, employers will need to await the actual release of the guidance to understand the full scope and details. Additionally, the guidance may be modified prior to finalization, based on comments received by stakeholders, including employer industry groups.
Of course, employers, as plan fiduciaries, will need to ensure their plans comply with the rules, once finalized. For the price transparency rules, employers will need to consult with their carriers, TPAs, PBMs, and other service providers to confirm they will prepare and post complete and accurate prescription drug MRFs for the employer’s plans, when required. However, ultimately, these rules should benefit employers by improving existing price comparison tools, so employers can more effectively compare coverage options, make informed decisions about plan benefits, and fulfill their fiduciary obligations to prudently select plan service providers.
Similarly, the proposed service provider compensation disclosure regulations may prove very helpful to employers, particularly those who contract with PBMs. Given the recent wave of fiduciary breach lawsuits against group health plan sponsors, employer industry groups have asserted that the proposed rules should also address how plan fiduciaries can select and monitor service providers in a way that prevents unwarranted litigation or even provide some type of a “safe harbor” for fiduciaries to show they engaged in a prudent decision-making process. Thus, the anticipated guidance may prove very insightful for employers, especially if drafted to address fiduciary concerns extending beyond PBM compensation.
Parting Thoughts
Faced with rising healthcare and prescription drug costs, employers may question whether transparency laws will ever achieve their stated objective of lowering prices through greater competition. Of course, our healthcare system and markets are complex, and there are multiple forces that drive pricing; (the lack of) transparency is one factor. However, as explained above, many provisions of existing transparency laws, including the TiC rule and CAA 2021, have never been fully enforced or tested. Despite the recent government shutdown, the current administration remains intent on changing this trajectory. Hopefully, the new rules and regulations will help to remove barriers to true price transparency, while providing employers with the necessary information to fulfill their related fiduciary obligations.
NFP will monitor the rulemaking closely and provide updates in future editions of Compliance Corner, available at nfp.com. For further information on transparency obligations or fiduciary governance, please ask your broker or consultant for a copy of the NFP publications Transparency and CAA 2021 Obligations of Group Health Plans and ERISA Fiduciary Governance: A Guide for Employers.