H.R. 9486, Health Plan Transparency & Audit Rights. Quorum's AI analysis reads it as a net benefit — and names who gains.
H.R. 9486 · Net good
What it does
This bill requires group health plans to audit and access de-identified claims data from healthcare providers, insurers, and pharmacy benefit managers to verify pricing, payments, and contract compliance. It prohibits these entities from blocking audits, charging excessive fees, or hiding pricing terms and overpayments. The bill also bars employers and plan sponsors from discriminating against workers based on health plan data and imposes civil penalties ($10,000/day for violations, $100/day per person for discrimination) for non-compliance.
The analysis names large self-insured employers (audit cost recovery) — and 2 more groups — among the beneficiaries.
The trade-off
Pharmacy benefit managers (PBMs) and healthcare networks face significant operational burden and cost exposure from unlimited audits and mandatory pricing disclosure, which may be passed to consumers or reduce service offerings.
Transparency scores 72%, with a medium warning level and no provisions unrelated to the bill's subject.
Who is behind it
Filed by Mark Takano.