Having more transparent prices for prescription drugs and healthcare services may facilitate market-based decisions by employers and health plans. But the impact on patients will likely be quite limited.

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Transparency in healthcare pricing is a hot topic in Washington DC these days, particularly since the prices of healthcare services and prescription drugs can be so shrouded in mystery. To take one example, recently passed legislation seeks to pry open the accounting pharmacy benefit managers do as intermediaries on behalf of their clients, employers and health plans in the commercial and public sectors. In addition, lawmakers have proposed ways of improving the clarity of medical billing and pharmacy costs for patients. But the impact of this push for transparency on patients’ out-of-pocket expenses is quite limited.

At an Energy and Commerce health subcommittee hearing in January on lowering healthcare costs, congressional members and policy experts highlighted healthcare price transparency as a possible solution to reduce out-of-pocket costs for patients.

At the meeting, Representative John James (R-MI) asked health insurance executives why they hid their prices unlike in other parts of the economy: “Why in healthcare do you hide our prices? You only hide things when you don’t want people to know what you are doing.” He contrasted the way airlines price tickets to healthcare. James is the lead sponsor of the bipartisan “Patients Deserve Price Tags Act,” which aims to ensure Americans receive transparent, upfront prices across healthcare services and technologies.

Shortly after the hearing, Health and Human Services Secretary Robert F. Kennedy Jr. said, “if you go to a restaurant and look at the menu, the prices are there. Healthcare is the only place where you can’t see your prices.”

In most markets throughout the economy, consumers actively comparison-shop, considering price and value parameters. Price transparency is a prerequisite for a properly functioning, competitive market in most sectors.

But for patients the question becomes, how relevant is transparency as a lever to reduce their out-of-pocket costs? On one hand, a lack of clear, upfront enumeration of costs means patients often don’t understand what they’ll owe until after receiving care in a clinic or hospital or getting a prescription. And so, publicly posting the actual out-of-pocket prices to patients prior to receipt of care could help consumers navigate options.

On the other hand, the healthcare market is qualitatively different. A person experiencing an acute event like a heart attack or stroke doesn’t have time to do price comparisons. And even under less critical circumstances, such as a person with diabetes or high blood pressure deciding upon treatment, it’s often not practical or even feasible to shop around.

Most episodes of care are not analogous to ordering something in a restaurant or buying an airline ticket. Patients usually don’t know in advance which tests or procedures they wind up needing, especially in emergencies or for complex diseases and conditions. As such, it’s unclear how much transparency would assist patients in a material way.

Nevertheless, lawmakers and regulators are undeterred by these arguments, as is evidenced by recent regulatory and legislative developments.

A bill that passed the House but has yet to go through the Senate would provide statutory authority for already existing federal regulations to require hospitals to annually publish their prices and related information, including the discounted cash price for services paid for by patients as well as payer-negotiated charges. Under current Centers for Medicare and Medicaid Services regulations, hospitals are already required to disclose certain prices. But non-compliance has been a major issue. The proposal would effectively codify CMS rules.

Additional provisions include mandatory semiannual reporting by PBMs on certain rebates and fees they’ve garnered in connection with drugs they cover and manage. Here, rebates are retroactive payments by drug manufacturers to PBMs in exchange for moving market share to particular products. The bill would also require full pass-through of rebates to the Medicaid program with nothing retained by PBMs as profit. And it would prohibit spread pricing in Medicaid, which occurs when PBMs charge the program more for medications than they reimburse the pharmacy, keeping the difference as profit.

While all of this sounds good from the perspective of several stakeholders, specifically pharmacies and those who contract with hospitals and PBMs, it does little for patients.

What further complicates matters, especially in the hospital space, is the reality that not all patients are able to use transparent information effectively. The complexity of medical billing, variations in pricing and frequent inaccuracies in the data can be daunting enough for a researcher like me. It’s even more challenging for laypersons to decipher prices and make informed decisions.

Perhaps then it’s not surprising that patients rarely use the transparent data. Zack Cooper, associate professor of public health and economics at Yale University, told MedPage why he believes growth in hospital prices is the biggest driver of healthcare costs, but that making prices more transparent for patients isn’t going to reduce costs. Patients aren’t pulling up a price transparency tool and shopping for healthcare services and technologies the way they do for everyday items in stores.

For a single procedure in a clinic or hospital, there can be a bewildering list of different prices, which include chargemaster prices, public or private insurer’s negotiated rates and cash-pay amounts.

What could be more helpful to consumers is if they better understood what their out-of-pocket costs would be for a service given their particular form of insurance. But this information often isn’t readily available, at least not for hospitals and clinics.

By contrast, transparent, online direct-to-consumer offerings, from drug manufacturer-based programs such as Lilly Direct and NovoCare, to TrumpRx, Mark Cuban’s Cost Plus Drug Company, GoodRx, BlinkRx and others, can illuminate precisely what patients owe for certain prescription medications. This does make the pharmaceutical space more suitable for enhanced transparency and its corresponding benefits in ways that other healthcare sectors aren’t.

This said, regardless of how transparent the pricing of care is, including pharmaceuticals, it’s often priced out of reach, even for those with insurance. And this in turn calls into question the favoring of high-deductible plans by the Trump administration to give consumers “skin in the game” as they’d supposedly be “incentivized” to make “smarter choices.” A deductible is the amount patients must pay before insurance kicks in. When deductibles are factored in, out-of-pocket costs for patients can sometimes run in the thousands of dollars. For some un- and underinsured, unreimbursed healthcare charges can lead to medical debt and bankruptcy.

If increased transparency isn’t the answer, it begs the question, what could meaningfully lower patients’ out-of-pocket costs? There aren’t any easy solutions, but reduced prices of care throughout all healthcare sectors would help.