Status as of October 27, 2026: S. 2355 has passed committee and is on the Senate calendar. It has not passed the Senate or the House and is not law.
What happened to the bill in the Senate?
On July 22, 2026, the Senate Health, Education, Labor and Pensions (HELP) Committee voted to advance S. 2355, the Patients Deserve Price Tags Act, with an amendment that replaced the bill’s text. Sen. Roger Marshall introduced the bill on July 17, 2025, with Sen. John Hickenlooper among the original cosponsors. According to the Healthcare Financial Management Association, the committee vote was 21 to 1, with Sen. Rand Paul voting no.
The bill was formally reported to the Senate and placed on the legislative calendar on July 27, 2026. Most coverage has focused on its hospital price disclosure rules. For an employer that sponsors a health plan, the more important part is a set of ERISA amendments that would give the plan a legal right to its own claims data.
Where does the bill stand now?
Since August, one thing has happened on the Senate floor. HFMA reported that the Senate appeared ready to pass the bill on an expedited basis on September 24, 2026, but Sen. Paul blocked the motion needed to speed the vote. As of HFMA’s October 1 report, the bill remained in limbo while Congress weighs health policies for a year-end package, and HELP Chair Bill Cassidy was working to pass it before he leaves Congress at the end of the year.
As of October 27, 2026, the bill’s record on Congress.gov lists no Senate floor vote after the July 27 calendar placement. Here is the path that remains:
| Step | Status as of October 27, 2026 |
|---|---|
| Introduced in the Senate | Done, July 17, 2025 |
| HELP Committee hearing | Done, March 19, 2026 |
| HELP Committee vote | Done, July 22, 2026 (21 to 1, per HFMA) |
| Reported and placed on the Senate calendar | Done, July 27, 2026 (Calendar No. 522) |
| Expedited Senate passage | Blocked September 24, 2026 (per HFMA) |
| Senate floor vote | Not yet held |
| House passage | Not yet held |
| Signed into law | No |
The House has its own versions. H.R. 5582 is the House companion, referred to committee in September 2025. A separate House transparency bill, H.R. 9393, the Lower Costs, More Transparency Act of 2026, was ordered reported by the Energy and Commerce Committee 45 to 0 on July 21, 2026. Any final law would need the House and Senate to agree on the same text, and the ERISA language could change along the way.
What would the bill give plan sponsors?
The reported bill, in Section 7, ties claims data access to ERISA section 408(b)(2), the rule that a plan’s service contracts must be reasonable. A contract with a covered service provider would not count as reasonable unless it meets the new data rules. Covered service providers include providers, networks, third-party administrators, insurers, pharmacy benefit managers and intermediaries between them and the plan.
| Provision in the reported bill | What it would mean for your plan |
|---|---|
| Access to all claims and encounter data and supporting documentation | The plan can check whether claims were paid accurately and reasonably |
| Access within 15 days of a request at most | Vendors cannot stall a data request |
| No limits on audit volume, auditor choice, scope or frequency | You pick the auditor and decide what gets reviewed |
| Disclosure of value-based and capitated payment terms | You see the formulas, quality measures and incentives behind those contracts |
| Disclosure of fees, including access, repricing, renegotiation and enhanced review fees | Fees cannot stay buried in the fine print |
| Unmodified 837 claim files and 835 remittance files, at no cost | You can verify claims independently instead of relying on summary reports |
| Disclosure of ownership interests between vendors and providers | You can see when a vendor has a stake in the providers it pays |
| Contract terms that limit access are void as against public policy | Restrictive clauses would not hold |
| Civil penalty of up to $10,000 per day | The Department of Labor could enforce the rules against vendors |
The bill also changes the annual gag clause attestation. Plans would have to attest that the data is available and that no contract term restricts audits, and a plan could not hand the attestation off to its TPA. If a plan cannot get the data, it would file a written statement explaining why and naming the vendor. Our explainer on the gag clause attestation covers how the current rule works.
Who would the rules apply to, and when?
As reported, the data access rules apply to group health plans offered by an employer that averaged at least 50 employees in the prior year, or plans that averaged at least 50 participants. They would take effect with the first plan year that begins at least one year after the bill is signed. The Department of Labor would implement them through notice and comment rulemaking.
The bill protects privacy. Vendors would provide data under HIPAA’s privacy rules and would not have to disclose information that could identify a member. A plan receiving the data could use it only for plan administration and could not sell or license it.
How is this different from price transparency rules?
The Transparency in Coverage rules already require insurers and self-funded plans to post machine-readable files of negotiated rates, and the Departments finalized updates to those rules in October 2026. Those files show what the market charges. They are large and aggregated, which makes them useful for research and comparison, and hard to use to check whether your own plan paid a claim correctly.
Claims data access works at the other end. It is claim-level, specific to your plan and backed by audit rights. Price transparency answers “what does the market charge.” Claims data access answers the question a plan sponsor has to answer: what did we pay, and was it reasonable?
Why does this matter for fiduciary risk?
Employees have sued large employers under ERISA, alleging that plan fiduciaries failed to monitor their PBM and let the plan overpay for drugs. Several of the best-known cases were dismissed for lack of standing and are on appeal, and at least one has a claim still moving forward. The ERISA health plan litigation tracker follows each case.
The legal outcomes are unsettled, but the argument is the same in every case: a fiduciary cannot prudently manage what it has never looked at. A legal right to claims data would not end that risk. It would remove the easiest excuse. An employer that has the data and uses it is in a very different position from one that never asked.
Pharmacy data is already moving this way. Federal PBM reform, enacted in February 2026, requires PBMs to report to plans and gives ERISA plans a yearly audit right. S. 2355 would extend the same idea to medical claims and every vendor that touches them.
What should you ask your carrier, TPA or PBM today?
You do not need to wait for Congress. Many of the rights the bill would guarantee already exist in some form in vendor contracts and are rarely used. The Consolidated Appropriations Act, 2021 already bars gag clauses that block a plan’s access to cost and claims information. Bring these questions to your next vendor meeting or renewal:
- Can we receive our full, unmodified 837 and 835 files today, not a summary report?
- What do we pay in access, repricing or enhanced review fees, and where is that written in our contract?
- Who may audit our claims, how often, and is there a cap on how many claims they can review?
- What formulas and incentives drive payments under any value-based or capitated arrangement in our plan?
- Does any clause limit our right to see our own data, and would it survive if this bill becomes law?
Ethos Benefits helps employers request and read this data through its claims analytics and audit work. For a broader view of where plan dollars go, see what happens behind the scenes with your health insurance.
What should employers do now?
Whether or not this bill passes in its current form, data access, audit rights and fee disclosure are becoming the expected baseline. The employers in the strongest position will already know what they would do with the data.
- Read your current contracts for data, audit and confidentiality terms, and note every limit.
- Request your claims files now, and record how long the vendor takes and what it provides.
- Build an audit plan, not just an audit clause you have never used.
- Fix restrictive language at renewal, before a law or a lawsuit forces it.
- Watch the year-end package. If the bill moves, the effective date will be counted from enactment.
Insisting on full data rights can change a renewal. Axiom Healthcare Services moved to a carrier with full data and audit rights and turned a 2.6% renewal increase into a 13% decrease. The Axiom Healthcare case study shows how.
This article summarizes pending federal legislation for general information and is not legal advice. S. 2355 has passed committee but has not been enacted, and its provisions and timing may change before final passage. Status reflects Congress.gov and published reports as of October 27, 2026.
