December 27, 2022.
If you’re an employer with a health plan for your employees, your HR team should have already had that date circled in your calendar.
It is the date by which, under the Consolidated Appropriations Act, all employer health plans are required to submit information on their health care spending, including pharmacy benefits, to the Department of Health and Human Services.
Before we get into the details, know that at some point there is the potential for penalties for noncompliance, so ignoring the law carries definite risk. (We say, “at some point,” because the reality is that HHS will likely adopt a more understanding stance with employers making a good-faith effort at compliance. At least for a year or two.)
In any case, the point of all this data-collection and reporting is to develop a comprehensive annual report beginning in 2023 on prescription drug prices and healthcare costs so that we all can get a clearer idea of their influence on premiums and consumers’ out-of-pocket costs.
This data submission is called the RxDC report. The Rx stands for prescription drug and the DC stands for data collection. (See the Resources section at the end of this article for links to reporting instructions, templates and more).
Employer health plans must file their initial reports by Dec. 27, and subsequent reports no later than June 1 every year.
The report must include:
- Beginning and end dates of their plan year;
- number of plan participants;
- enrollment and premium information, including average monthly premiums paid by employees vs. employers;
- total health care spending broken down by type of cost (primary care; hospital care; specialty care; prescription drugs; and other medical costs, including wellness services), including prescription drug spending by enrollees vs. employers and issuer;
- the 50 most frequently dispensed brand prescription drugs;
- the 50 costliest prescription drugs, based on total annual spend;
- the 50 prescription drugs that had the biggest increase in plan or coverage expenditures over the previous year;
- the prescription drug rebates, fees and other remuneration paid by drug manufacturers to the plan or insurer in each therapeutic class of drugs, as well as for each of the 25 drugs that yielded the highest amount of rebates;
- the impact of drug rebates, fees and other remuneration on premiums and out-of-pocket costs.
Employers with fully insured group health plans, where all prescription drug coverage is provided through the group health plan, can rely on their carrier to submit the necessary data to Centers for Medicare and Medicaid Services, or CMS. However, if a fully insured employer covers some prescription drug costs through separate arrangements, such as a specialty drug carve-out or a separate mail-order drug benefit, additional reporting work will likely be required.
Employers with self-insured plans will need to rely on their third-party administrators and other vendors to provide them with the required data for submission to CMS, or to submit the data on behalf of the employer’s plan.
Either way, CMS has made it clear it is the employer’s responsibility to work with their vendors to ensure reporting is completed.
By Dec. 27, of course.
- RxDC reporting instructions (PDF)
- RxDC templates (ZIP)
- RxDC drug name and therapeutic class crosswalk (ZIP)
The Mahoney Group, based in Mesa, Ariz., is one of the largest independent insurance and employee benefits brokerages in the U.S. An employee-owned organization, we’ve been providing our clients with the confidence to face whatever lies ahead for more than 100 years. For more information, send us a note via our website or call 877-440-3304.
This article is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.