Let's be

Rx Savings Solutions has been offering price transparency in the complex prescription drug market for more than a decade. It’s what we do. That’s one reason we haven’t been surprised to see new federal regulations aimed at giving consumers access to real-time healthcare costs—including drug pricing.

As these policies begin to take effect, our question is: Are you ready?

Our proven solution can help make sure you are.

rxss transparency explainer image

The basics: New CMS Requirements

The Centers for Medicare and Medicaid Services (CMS) Transparency in Coverage rule (CMS-9915-F) requires private insurers to post real-time cost-sharing information, out-of-pocket coverage rates and in-network drug pricing. In short, transparency is no longer voluntary. Penalties for non-compliance could be as high as $300 per plan participant per day.

NEW UPDATE: While enforcement of these new regulations may be delayed, here are some key dates to keep in mind:

Timeline showing July 2021, January 2023 and January 2024

Historical drug prices, in-network rates, out-of-network historic payments and billed charges must be made public.

Standard costs for an initial list of 500 medical items and services must be available in an internet-based self-service tool.

Costs for all covered services and prescription drugs must be available in an internet-based self-service tool.

July 2022

Historical drug prices, in-network rates, out-of-network historic payments and billed charges must be made public.

january 2023 icon

Standard costs for an initial list of 500 medical items and services must be available in an internet-based self-service tool.

january 2024 icon

Costs for all covered services and prescription drugs must be available in an internet-based self-service tool.

An older man and woman drinking tea and laughing

What About
Medicare Advantage?

Effective January 2023, another CMS regulation (CMS-4190-F2) will require Part D plans to offer their beneficiaries access to a Real-Time Benefit Tool (RTBT). This comparison tool must allow enrollees to review options under their current prescription drug plan and give them the ability to choose lower-cost alternative therapies. Fortunately, our solution already meets these RTBT requirements.

Transparency Blog Series

Check out our ongoing blog series on price transparency to learn more about what these new regulations will mean to your organization.

On One Condition – Diabetes

We’ve been recognizing American Diabetes Month the same way we treat every other month: By helping members find the lowest-cost options to treat this chronic condition.

Read More
A tablet sits on a desk with a screen that reads: "Transparency in Coverage - CMS 9915-F"

Delays or Not, Employers Should Still Prep for Transparency in Coverage

Despite enforcement delays, group health plans should keep moving toward price transparency. They have more to gain than compliance.

Read More
A man and woman sit on the couch smiling

Embrace Transparency and Engagement Will Follow

Rather than simply comply, health plans can use CMS transparency rules to create a better member experience. Engagement and satisfaction are the natural byproducts.

Read More
Pills and tablets with dollar amounts printed on them are viewed under a magnifying glass

Once a Carrot, Here’s Why Transparency Will Stick

Soon all commercial, Medicare Advantage and employer-sponsored health plans will be required to publish prices for a variety of services, including prescription drugs. A boon for consumers, and an opportunity for plans.

Read More

Why Transparency Matters

Aside from avoiding costly penalties, you may be asking: Why should I embrace price transparency? The answer really comes down to trust. By educating your members on all their medication options, you solidify your role as trusted partner. And with trust comes three key benefits:

Looking Beyond Compliance

After more than 10 years helping our clients and members make sense of prescription drug pricing, we’ve learned that simply complying with regulations isn’t enough. Yes, RxSS technology creates the drug price transparency CMS is soon requiring. But we take that data a step further and share it with members in a way that empowers them to take action and take control of their out-of-pocket drug costs. Here’s how we do it:

Offer a proven platform for member engagement. How it Works

Partner with health plans and employers to drive ROI.

Client Case Study

Enhance the experience for Medicare Advantage members. More About MA
Someone viewing their Rx Savings Solutions member account on a latptop

Request a demo

We can talk about it and get deep into the weeds, but seeing is believing.

What you Can Expect

green checkmark icon

A clear picture of clinical strength, plan integration and a simple, intuitive user experience.

green checkmark icon

How easy it is for a member to save money for themselves and your plan.

green checkmark icon

Why Rx Savings Solutions blows away other so-called "savings tools."

X