H.R. 9117, Healthcare Price Transparency & Disclosure Mandate. Quorum's AI analysis reads it as a net benefit — and names who gains.
H.R. 9117 · Net good
What it does
The CHECK Act requires health plans and their service providers (including pharmacy benefit managers, third-party administrators, and networks) to disclose detailed pricing, fee schedules, rebates, and payment data to group health plans quarterly at no cost, and mandates that health plans provide patients with clear, itemized explanations of benefits within 45 days of a claim request. It also requires healthcare providers to furnish itemized bills within 30 days of final payment, with plain-language descriptions and billing codes, and prohibits collection actions unless the provider complied with these requirements or documented medical necessity for charges exceeding good-faith estimates.
The analysis names health plans (gain cost-control data and leverage in negotiations) — and 2 more groups — among the beneficiaries.
The trade-off
Pharmacy benefit managers and third-party administrators face significant operational burden and cost to extract, format, and transmit detailed rebate and fee data quarterly; this may accelerate consolidation or shift costs to plan sponsors and ultimately premiums.
Transparency scores 75%, with a medium warning level and no provisions unrelated to the bill's subject.
Who is behind it
Filed by Nicholas Langworthy.