Author: Jude Odu

For five years, hospitals satisfied federal price transparency rules by publishing “estimated allowed amounts” that often had little relationship to what your plan actually paid. As of April 1, 2026, that ended.

The CY 2026 OPPS final rule replaced the estimate with three real numbers: median, 10th percentile, and 90th percentile allowed amounts, all drawn from 12 to 15 months of actual claims. Hospital CEOs must now attest the data is true, accurate, and complete.

That changes what ERISA expects of plan sponsors. If your plan is paying above the 90th percentile for common procedures at hospitals you can now benchmark in minutes, that gap is hard to defend.

Here is what the change means for your plan, and the three things you can do this week.

GLP-1 drugs now account for 14% of prescription spend in employer-sponsored health plans. At $400 to $700 per member, per month, a few hundred employees can add millions to your annual plan cost. If you are a self-funded plan sponsor without a documented GLP-1 coverage policy, you face both financial exposure and ERISA fiduciary risk. Here is what to pull, evaluate, and decide this week.