New Pharmacy Data Collection Requirements
Will your plan be ready in December 2022?

When the 2021 Consolidated Appropriations Act (CAA) was enacted just before the New Year, the far-reaching impact on employer-sponsored group health plans was unknown. As it turns out, the CAA requirements have impacted group health plans in many areas, including new cost transparency, surprise billing and pharmacy data reporting requirements. Deadlines for implementing cost transparency reporting and surprise billing have come and gone. The next hurdle on the CAA track is pharmacy data collection (RxDC).

What Is RxDC Reporting?

In a nutshell, the CAA RxDC regulations require both insured and self-funded group health plans to submit to CMS detailed information about prescription drug utilization and cost, as well as healthcare spending. The goal of collecting this information is to help identify major drivers of drug and medical spending, gain an understanding of how prescription drug rebates impact premiums and out-of-pocket costs, and promote transparency in prescription drug costs. Ultimately, CMS will publish findings based on the data collected from group health plans.

The initial deadline for the first RxDC report is December 27, 2022. This initial deadline is for data from the 2020 and 2021 plan years. Going forward, the reports will be due by June 1 of the next calendar year. This means the report with 2022 data will be due by June 1, 2023.

How Will RxDC Reporting Be Handled?

Similar to the initial transparency reporting that was due by July 1, 2022, the RxDC reporting will be completed by insurers, third-party administrators (TPAs), and pharmacy benefit managers (PBMs). This is because the data lies with these entities. For insured plans, it will be completed by the insurance company. For self-funded plans, the responsibility technically falls directly to the plan sponsor, but it can and should be delegated to the TPA and PBM. In either case, a written contract (or amendment to an existing service agreement) is required to protect the plan sponsor from liability for failure to report.

What Action Do Plan Sponsors Need to Take?

At this point, your NFP Service and Compliance teams are working with the insurance carriers, TPAs and PBMs in the Indiana market to ensure they will be ready by the December 27, 2022, deadline. In addition, we will ensure that the appropriate contractual provisions are being put in place to formally delegate responsibility to the carrier, TPA and PBM. For self-funded employers with a “carved out” PBM (separate from the TPA), we are coordinating to ensure that both parties complete their relevant portions of the reporting requirement. Finally, TPAs and insurers have begun sending out information to plan sponsors explaining their compliance approach for RxDC reporting. Depending on the insurer or TPA, the plan sponsor may be asked to provide data related to premium costs. Your NFP analytics consultants are submitting the necessary information on your plan’s behalf, so no action needs to be taken on your part. More details and FAQs regarding RxDC reporting are available here. If you have any questions, please reach out to your NFP Account team for additional details applicable to your plan.