In April 2018, the ESRB starting adding an additional element to physical game boxes, warning parents that the product contains an in-game purchase. Announced today on the ESRB blog, they will be taking this a step further, but elaborating on the rating for those games that contains random elements.
The terminology "In-Game Purchases (includes Random Items)" will be assigned to those games that have loot boxes, card/items packs, or premium currencies. This will better inform consumers at the time of purchase, either physically or digitally, precisely what they can expect to find in-game. The original "In-Game Purchases" designation will still be included on all games that allow for the direct purchase of additional content not categorized as randomized, such as expansions, cosmetic items, extra levels, etc.