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Rx Cost Reporting Deadline Extended

As we previously reported, as part of transparency in health coverage requirements which were passed under the Transparency in Coverage Final Rule and the Consolidated Appropriations Act in 2021, employer plans are required to report detailed prescription drug cost information to the agencies, including the 50 most commonly covered drugs per plan, the 50 most expensive drugs per plan, and the total health spending for each plan broken out into specific categories.

The reporting deadline has been delayed several times over the years. The first report (for the calendar year ending in 2020) was due December 27, 2021, and for subsequent calendar years, the report was to be due annually by June 1. The Departments of Labor, Health and Human Services and Treasury (the agencies) temporarily deferred enforcement against a plan or issuer that submits the required information for 2020 and 2021 by December 27, 2022. Again, on December 23, 2022, the agencies issued Frequently Asked Questions (FAQs) which provide a grace period until January 31, 2023 for completion of data submissions. Until this date, the agencies will not initiate enforcement action against a plan that makes a good faith effort to complete submission.

The FAQs also provide guidance on allowing multiple submissions by the same reporting entity, submitting plan list via email to HHS (providing that certain requirments are met), and optional vaccine reporting.

Next Steps for Employers

It is important for employers to work with their carriers, third-party administrators (TPAs or vendors), or legal counsel to meet their reporting requirement obligations before the end of the grace period on January 31.

HR Works, headquartered in Upstate New York, is a human resource management outsourcing and consulting firm serving clients throughout the United States for over thirty years. HR Works provides scalable strategic human resource management and consulting services, including: affirmative action programs; benefits administration outsourcing; HRIS self-service technology; full-time, part-time and interim on-site HR managers; HR audits; legally reviewed employee handbooks and supervisor manuals; talent management and recruiting services; and training of managers and HR professionals.