Following February’s Executive Order, CMS, the Labor Department, and the Treasury Department recently dropped new guidance that pushes us further toward standardization, enforcement, and real usability of price transparency data.

At Serif Health, we’ve always believed transparency data only matters if it can be trusted, compared, and acted upon. Recent updates show the federal government is continuing to lean in toward these goals.

Here’s what stood out to us:

• Payers are on notice. The latest TiC FAQs confirm that health plans are expected to report in-network and out-of-network rates—clearly and completely. Enforcement is no longer just a threat, it’s a direction from the White House. An improved TiC schema is also on its way but will not be required until February 2026.

• Prescription drug transparency is getting long-awaited attention.  A new Request for Information also invites public input on how to implement the prescription drug machine-readable file requirement of the TiC final rule. The RFI seeks stakeholder feedback on data elements, frequency, and usability to make the files more meaningful for patients, researchers, and purchasers. While the standalone Rx files are still evolving, negotiated rates for provider-administered drugs are already widely reported and ready to be assessed through our products.

• Hospital file standardization is picking up speed. Following up on rulemaking from 2024, CMS is also aligning hospital machine-readable files more closely with payer TiC specs and ending the placeholder era (“999999999”). CMS will now require hospitals to include actual allowed amounts based on historical data in their machine-readable files, replacing placeholders like “999999999” that had previously limited analysis. More structure = more signal = more value.

And it’s not just regulators pushing for change. In a case closely watched by employers and benefit leaders, the Sixth Circuit recently reversed the dismissal of an ERISA lawsuit against Blue Cross Blue Shield of Michigan over alleged plan overpayments, reestablishing a key question about fiduciary responsibility in how healthcare plans are administered. 

Meanwhile, there are rumblings in Congress too. New legislation such as the transparency provisions in H.R. 1 (the so-called Big Beautiful Bill) signals that lawmakers are eyeing broader reforms around pharmacy benefit managers (PBMs). If passed, these measures could one day require PBMs to publicly disclose drug-level rebate, pricing, and reimbursement information. While these proposals are still early stage, they reflect growing bipartisan momentum toward full accountability in prescription drug pricing in addition to medical services.

Taken together, this is the clearest signal yet that price transparency is entering its next phase. Not just as a regulatory requirement, but as a core input for business strategy, plan design, and improved marketing for all sorts of healthcare organizations. The opportunity now is to shift from retrospective audits to real-time decisions. Payers and self-funded employers are under increasing pressure to validate what they are paying, why, and how it compares.

At Serif Health, we’re making transparency work: our combination of payer- and hospital-posted machine-readable files, best-in-class processing and enrichment, and billions of claims records powers benchmarking, contracting, and strategic decision making across the healthcare ecosystem. 

And we are only getting started. Serif Health is expanding Signal’s analytical capabilities to go deeper into provider network structures, referral patterns, time trend analysis, and peer rate benchmarking. We're also continuing to make data more usable—standardizing across CSTM codes, normalizing carrier references, and integrating new file formats as standards evolve.

We’ll be staying busy this summer! We’re delivering APIs, dashboards, and insights that help customers fully leverage price transparency data. At Serif Health, we’re committed to the promise of radical price transparency. If you’ve read this far, we’d love to hear from you. Let’s talk about how our price transparency data and tools can help your organization take the next step. Please reach out to discuss how you can use our data or check out our sample data on our web platform Signal.