April 6, 2023
On March 3, 2023, federal agencies released Prescription Drug Data Collection (RxDC) Reporting Instructions applicable to the 2022 reference year. RxDC reporting for the 2022 reference year is due on or before June 1, 2023.
The Consolidated Appropriations Act, 2021 (“CAA, 2021”) includes a provision that requires group health plans and health insurance issuers (collectively “plans and issuers”) to report certain specified data related to prescription drug and other health care spending, including, but not limited to: (1) general information regarding the plan or coverage; (2) the 50 most frequently dispensed brand prescription drugs; (3) the 50 most costly prescription drugs by total annual spending; (4) the 50 prescription drugs with the greatest increase in plan expenditures over the preceding plan year; (5) total spending by the plan or coverage broken down by the type of costs; (6) the average monthly premiums paid by participants, beneficiaries, and enrollees and paid by employers; and (7) the impact of premiums on rebates, fees, and other remuneration paid by drug manufacturers to the plan or coverage or its administrators or service providers, including the amount paid with respect to each therapeutic class of drugs and for each of the 25 drugs that yielded the highest amount of rebates and other remuneration under the plan or coverage from drug manufacturers during the plan year.
While the deadline for reporting 2020 and 2021 reference years was extended to January 31, 2023, the deadline for reference year 2022 reporting is June 1, 2023.
2022 Reference Year Reporting Changes
In anticipation of the June 1, 2023 deadline for reference year 2022 reporting, the agencies took into consideration some of the complexities from the 2020-2021 reference year reporting and made some changes to the filing requirements. These changes are summarized below:
Additionally, the new guidance clarifies that RxDC reporting does not apply to retiree-only plans; however, it does apply for plans located in U.S. Territories (in addition to all 50 states and D.C.). Note for self-funded plans: When calculating premium equivalents, a self-funded plan may use the same types of costs that are used to develop COBRA premiums; however, it should report the total dollar amount actually paid for the reference year, rather than the amounts used to set the COBRA rate.
In our experience, carriers, TPAs, PBMs and other vendors have varying requirements and expectations of what they need from plan sponsors to successfully complete the reporting, and some may even be delegating some of the reporting responsibility to the plan sponsor. For example, if your insurance company, TPA, or PBM sent you a survey or questionnaire to collect information about plan numbers, premium, or funding types, it is likely that they are reporting the P2 and D1 files on your behalf. Therefore, it is important to respond to any requests for information you may receive from the carrier, TPA, PBM, or other vendor and to coordinate with them to understand their expectations to ensure all reporting is completed in full on behalf of the plan. If your vendor sent you a letter telling you to create a HIOS account or stating that they will not submit P2 and D1 on your behalf, that means you must submit P2 and D1 directly to CMS (or engage a third-party to submit them for you).
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About the Authors. This alert was prepared for The Fedeli Group by Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act. Contact Stacy Barrow or Nicole Quinn-Gato at firstname.lastname@example.org or email@example.com.
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