Prescription Drug Reporting Due by December 27, 2022
December 8, 2022
A new transparency provision, enacted as part of the 2021 Consolidated Appropriations Act, requires employer-sponsored health plans and health insurance issuers to annually report information about prescription drugs and healthcare spending to the federal government. This reporting process is referred to as the “prescription drug data collection” (or “RxDC report”).
The first RxDC report is due by December 27, 2022, and covers data for calendar years 2020 and 2021 (referred to as the reference years). Going forward, the annual deadline is June 1 of the calendar year immediately following the reference year. Therefore, the RxDC report for calendar year 2022 will be due June 1, 2023.
Impact on Employers
The RxDC reporting requirement applies to employer-sponsored group health plans, including fully insured plans and self-funded plans. However, account-based plans (such as HRAs) and excepted benefits are exempt from RxDC reporting. According to interim final rules, employers may use issuers, third-party administrators (TPAs), pharmacy benefit managers (PBMs) or other third parties to submit the RxDC reports on their behalf. Federal agencies have stated that, although employers can submit these reports on their own, they expect it will be rare for employers to do so.
Most employers will rely on their TPAs, PBMs or issuers to provide the RxDC report for their health plans. Therefore, employers should reach out to these vendors to confirm that they will submit the RxDC reports for their health plans. Employers should also update their written agreements with these third parties to reflect this reporting responsibility. In addition, employers with self-funded plans should monitor their TPA’s or PBM’s compliance with the RxDC reporting. Unlike fully insured plans, the legal responsibility for RxDC reporting stays with a self-insured plan even if its TPA or PBM agrees to provide the report on its behalf.
Additional information, including the RxDC reporting instructions, is available through the RxDC website.
Hylant held a live webinar on November 10, 2022 to discuss this topic. Click here to view the recording.
The above information does not constitute advice. Always contact your employee benefits broker or trusted adviser for insurance-related questions.
A.J. is an experienced client executive with 16 years of experience in the insurance industry. He is responsible for business development and client retention, specializing in employee benefits.