A new federal proposal aims to tighten oversight of health care "middlemen" and strengthen enforcement of existing transparency requirements across the health care system.
Nick Langworthy, a Republican congressman from New York, has introduced the Clear Healthcare Expense Cost Knowledge (CHECK) Act, legislation designed to expand transparency obligations across pharmacy benefit managers (PBMs), third-party administrators (TPAs), insurers and health care providers, while adding stricter disclosure timelines and enforcement mechanisms aimed at improving accountability across the system.
The bill builds on prior health care price transparency efforts but shifts emphasis toward enforcement and data access, particularly in relation to health care middlemen that play a central role in claims processing, pricing and reimbursement flows. It would require expanded reporting of claims, pricing, rebate and payment data, while also prohibiting contractual "gag clauses" that restrict employers and health plans from accessing full spending information.
For employers, the legislation would increase visibility into health care spending patterns by requiring PBMs, TPAs and other intermediaries to disclose detailed claims and pricing data to health plans on a quarterly basis. For patients, it would require insurers to provide more detailed Explanation of Benefits statements within 45 days of claims processing, including plain-language breakdowns of services, billing codes, insurance payments and cost-sharing obligations.
The proposal also targets provider billing practices, requiring health care facilities to issue itemized medical bills before pursuing payment or initiating collections. It would further limit charges that exceed previously disclosed estimates unless providers can demonstrate medically necessary changes or patient-requested adjustments.
While health care transparency initiatives have been enacted in previous regulatory and legislative cycles, the CHECK Act reflects a broader shift toward enforcement-driven transparency, with increased scrutiny on intermediaries viewed as central to cost complexity in the system.
Employer groups have historically supported expanded health care pricing transparency, particularly where it improves visibility into claims, pharmacy pricing and plan spending, though they caution that new disclosure requirements must be standardized to avoid adding administrative complexity. Pharmacy benefit managers and insurers have typically pushed back on expanded rebate and claims-level disclosure mandates, arguing that such requirements could increase reporting burdens and potentially disrupt negotiated pricing arrangements. Patient advocacy groups, meanwhile, have generally supported stronger transparency rules aimed at reducing surprise billing and improving upfront cost clarity.
The legislation comes amid a broader policy trend in which health care transparency efforts are evolving from disclosure-focused rules toward more enforceable accountability measures. Earlier initiatives largely centered on improving patient-facing cost clarity, while newer proposals increasingly emphasize claims-level access, employer visibility into spending flows and penalties for noncompliance.
The CHECK Act applies broadly to ERISA-regulated health plans as well as self-funded, non-federal governmental health plans.
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