FTC Warning Letters and Final Transparency in Coverage Rules Mark Latest Steps in Trump Administration’s Healthcare Price Transparency Push

I. Price Transparency in Healthcare Remains a Focus of the Trump Administration

On October 5, 2026, officials from the Trump administration announced two additional actions in a broader effort to increase healthcare price transparency. First, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced final amendments to the Transparency in Coverage (TiC) rules governing pricing disclosures by group health plans and health insurance issuers.¹ Second, the Federal Trade Commission (FTC) sent warning letters to the nation’s largest healthcare services companies stating that failure to provide patients with timely, accurate, and complete pricing information can constitute an unfair or deceptive practice under Section 5 of the FTC Act.²

The administration sees price transparency as a key tool to address rising costs by giving patients the information to make informed healthcare decisions. These announcements build on earlier efforts, including the Department of Justice’s (DOJ) recent settlement with OhioHealth,³ and reflect the administration’s continued pursuit of price transparency through regulation, antitrust enforcement, and consumer protection enforcement simultaneously.

II. Final TiC Rules

The TiC rules were originally issued by HHS, Labor, and the Treasury (the “Departments”) in 2020 under the first Trump administration and require most group health plans and health insurers to publicly post machine-readable files (MRFs) of their negotiated in-network rates, out-of-network allowed amounts, and prescription drug prices, as well as to give enrollees personalized cost-sharing estimates through an online tool. President Trump’s Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” directed the secretaries of the Departments to revisit these rules because “progress on price transparency at the Federal level has stalled.”⁴

The Departments identified three barriers to the 2020 rules’ effectiveness: file sizes that made the data inaccessible, a lack of contextual information, and misalignment with the Hospital Price Transparency rule.⁵ The Departments proposed the amendments in December 2025 to address these barriers.⁶ Key changes include:

• Network-level reporting and smaller files. Plans and issuers must prepare one In-network Rate File per provider network rather than per plan and must exclude provider-rate combinations unlikely to be reimbursed given the provider’s specialty. New Taxonomy and Utilization Files will disclose the exclusion rules used and the providers actually reimbursed.
• Expanded out-of-network data. Out-of-network Allowed Amount Files must be aggregated by market type, the reporting threshold falls from 20 to 11 claims, the reporting period is extended from 90 days to six months, and the lookback period is extended from 180 days to nine months.
• Quarterly cadence and standard format. In-network Rate and Allowed Amount Files will be posted quarterly rather than monthly in a single format the Departments intend to specify as JSON. Plans and issuers must also publish a root-folder text file and a homepage footer link identifying the MRF location, aligning with Hospital Price Transparency requirements.
• Attestation. Each MRF must include an attestation that the data is true, accurate, and complete and must name the chief executive officer, president, or senior official designated to oversee the data.
• Phone-based cost-sharing disclosures. Cost-sharing information available through the online self-service tool must also be available by phone on request, which the Departments concluded satisfies the No Surprises Act cost-sharing tool provision.

The rules will take effect 60 days after Federal Register publication (on December 7, 2026). The In-network Rate and Allowed Amount File amendments apply five months after publication (on March 6, 2027); the Taxonomy, Utilization, and text file requirements apply 11 months after publication (on September 6, 2027); and the self-service tool amendments apply for plan years beginning on or after January 1, 2027. 

III. FTC Warning Letters

Alongside the final TiC rules, FTC Chairman Andrew Ferguson sent warning letters to 24 unidentified healthcare services companies to remind them of their obligation to provide patients with timely, accurate, and complete pricing information, especially “for non-emergency services that are scheduled in advance.”⁷ The letters state that CMS’s price transparency rules establish a critical baseline but that compliance with them does not satisfy a healthcare service provider’s Section 5 obligations or provide a safe harbor from liability under the FTC Act. The letters describe two paths to liability:

• Deception. Because price is a material term, clear and conspicuous disclosures are often needed. Failing to disclose a price may be deceptive if the omission is likely to mislead reasonable consumers, as may an incomplete disclosure (for example, one that omits physician or facility fees or covers only part of the expected course of care), because patients may reasonably believe they have been told the total cost. Inaccurate disclosures are likewise misleading.
• Unfairness. Failing to provide transparent pricing may be unfair if it causes substantial injury that consumers cannot reasonably avoid and that is not outweighed by countervailing benefits, as when price information is incomplete, inaccurate, or not provided sufficiently in advance for consumers to compare providers. The letters add that such practices undermine competition by obscuring one of competition’s most important dynamics from consumer comparison.

The competition rationale is consistent with DOJ’s theory in OhioHealth that payor contracts limiting price transparency inhibit patients’ ability to choose between competing providers and can violate the Sherman Act.⁸ Because Section 5’s consumer protection authority does not require a showing of market power, the FTC may apply it to providers that Sherman Act claims would not reach.

Chairman Ferguson urged recipients to conduct a comprehensive review of their price disclosure practices and take swift corrective action as needed. At the administration’s October 5 press event, Chairman Ferguson said all providers, whether or not they received a letter, must disclose prices to consumers starting that day and that the FTC would take non-disclosing providers to court.⁹

IV. Key Takeaways

• Price transparency is a coordinated, multi-agency priority. Within a year, the administration has addressed healthcare pricing through CMS hospital enforcement, a DOJ Sherman Act settlement, FTC Section 5 warning letters, and a final tri-agency rule. Pricing practices that may raise concerns under one regime should be expected to draw attention under the others.
• Hospitals and health systems should review patient-facing disclosures as well as regulatory filings. The FTC’s position is that full compliance with CMS’s rules does not foreclose Section 5 exposure based on what patients are told when scheduling care. Systems whose payor contracts limit sharing of pricing information should also revisit those terms in light of the OhioHealth settlement.
• Plans and issuers face new accountability requirements on a short timeline. The attestation and named-executive requirements raise the stakes for MRF accuracy, and the five- and 11-month applicability periods leave limited time for required systems changes, even with the reduced reporting cadence.

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The Goodwin Healthcare team will continue to monitor price transparency regulations and litigation, any FTC investigations or enforcement action, and the Departments’ implementation guidance. For more information on the issues discussed in this alert, please contact the authors or Goodwin’s Healthcare Regulatory and Compliance group, Antitrust and Competition group, or the Goodwin lawyer with whom you typically consult.

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