PCMA, Chamber of Commerce sue to block Trump admin's insurer transparency rule

The Pharmaceutical Care Management Association (PCMA) has filed suit to challenge parts of the Trump administration's insurer price transparency rule.

The PCMA's suit, filed Thursday, comes on the heels of a suit from the U.S. Chamber of Commerce challenging the regulation, which was finalized in late October 2020. Under the rule, private payers are required to provide patients upfront with pricing that has been negotiated with providers, including real-time cost-sharing data.

Beginning in 2023, insurers must offer an online tool that provides out-of-pocket cost estimates for 500 of the "most shoppable" services. By 2024, that platform must extend to all services, according to the rule.

Insurers argued that launching these tools would be a costly endeavor that would provide data that confuses consumers.

The PCMA is directly challenging a part of the rule that would require its pharmacy benefit manager members to report the historical pricing data on prescription drugs. The group said it was not challenging other transparency tenets in the rule.

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"These parts of the Trump administration’s transparency rule will drive prescription drug costs higher," the PCMA said in a release. "By requiring disclosure of 'historical' net prices, which are essentially current year net prescription drug prices, the rule will directly provide drug manufacturers access to their competitors’ negotiated rebates, discounts, and price concessions."

"This in turn will allow drug manufacturers to discount less deeply as they realize their price concessions went beyond those of competitors," the PCMA said.

The chamber's lawsuit challenges provisions that require pricing data to be made available in a massive, machine-readable file to allow third-party develop shopping tools for consumers.

The organization, which represents a slew of employers and industries, said the requirements are not actually consumer-centric, and are "in fact counterproductive, wasteful, and unlawful.”

“These provisions of the rule threaten to reduce competition, and ultimately raise costs to consumers, by revealing confidential, commercially sensitive information that competitors currently do not share with each other," the chamber said in its lawsuit. "The required public disclosure of that closely guarded information runs afoul of long-established protections against the forced disclosure of confidential commercial information, including trade secrets, and is detrimental to the business community as a whole.”

The PCMA said it supports other solutions to price transparency, such as real-time benefit tools that offer pricing information at the point of care to both patients and providers.