Healthcare Transparency Legislation/Executive Orders Summary

Over the past seven years (2018–2025), U.S. healthcare policy has experienced significant shifts through executive orders and legislation across the Trump, Biden, and second Trump administrations. Here's a concise overview starting with most recent:​

April 15, 2025, Executive Order regarding EO13948 UPDATED from 2020 origin –

Lowering Drug Prices by Putting America First:

• Purpose: Address the high cost of prescription drugs in the U.S., where Americans pay more per capita than residents of other developed countries.

• Most-Favored-Nation (MFN) Pricing Model:

  • Develop a payment model for Medicare Part B drugs under the Secretary of Health and Human Services. Currently ASP+6%. Site-neutral.

  • Medicare would pay no more than the lowest price that drug manufacturers receive in other economically comparable countries (the "most-favored-nation" price).

  • Test whether aligning U.S. drug prices affects quality of care.

  • 13-year eligibility timeline Directed HHS to delay Medicare price negotiations for small-molecule drugs, aligning their negotiation timeline with biologics, and aimed to standardize payments across care settings. ​

• Revocation/Rescission of Previous Orders (January 2025): Revoked several Biden-era executive orders related to pandemic response and health equity initiatives.

  
  

Executive Order 14216 – Healthcare Price Transparency (Feb 25, 2025):

• Mandates healthcare providers and insurers to disclose actual prices for services and items.

• Requires standardized price formats for easier comparison by patients.

• Enforce compliance within 90 days Directs HHS, Treasury, and Labor Departments to do so.

• Enforcement policies for noncompliance updated with pricing transparency rules.

  
  

Key Healthcare Provisions of the CAA 2021:

1. No Surprises Act This act protects patients from unexpected medical bills by prohibiting surprise billing for emergency services and certain non-emergency services provided by out-of-network providers at in-network facilities. It also establishes a framework for resolving payment disputes for insurers and providers.

2. Healthcare Transparency Measures

• Removal of Gag Clauses: The CAA bans contractual provisions that prevent insurers from sharing cost/quality information with patients and plan sponsors.

• Pharmacy Benefit Reporting: Insurers and pharmacy benefit managers are required to report detailed information on prescription drug costs and rebates to federal agencies.

• Broker Compensation Disclosure: Brokers and consultants must disclose their compensation to employer-sponsored health plans, promoting transparency in plan costs. ​ 

• Fiduciary Responsibilities under ERISA: Plan fiduciaries must act prudently and solely in the interest of plan participants and beneficiaries/formal written signed Plan Document.

  
  

2018–2020: Trump Administration (First Term):

• Health Care Freedom Act (2017–2020): Proposed repealing the ACA's individual mandate and suspending the employer mandate until 2025. It maintained dependent coverage up to age 26 and allowed states more flexibility in managing Medicaid and insurance exchanges.

• Drug Pricing Initiatives: SINCE BEEN REVOKED in April 2025 Introduced executive orders aiming to reduce prescription drug costs by aligning Medicare payments with international prices and promoting transparency in drug pricing.​

  
  

Transparency in Coverage Final Rule 2020:

• Though technically a CMS rule (not ERISA), it complements ERISA by requiring:

  • Machine-readable files for negotiated rates.

  • Cost-estimator tools for members.