The Consolidated Appropriations Act, of 2021 (CAA) included a new annual reporting requirement for group health plans and health insurers to report certain specified data related to prescription drugs and other healthcare spending. As a result, insurance companies and employer-based health plans must submit information about prescription drugs and healthcare spending to the Centers for Medicare and Medicaid Services (CMS). This data submission is called the RxDC report. The next RxDC report for all group health plans is due June 1, 2024, covering 2023 calendar year data.
Insurance companies and employer-based health plans must submit information about:
- Spending on prescription drugs and health care services;
- Prescription drugs that account for the most spending;
- Drugs that are prescribed most frequently;
- Prescription drug rebates from drug manufacturers; and
- Premiums and cost-sharing that patients pay.
Employers may use issuers, third-party administrators (TPAs), pharmacy benefit managers (PBMs), or other third parties to submit the RxDC reports on their behalf.
Next Steps
For fully insured employers, the carrier will be responsible for completing the necessary reporting, but employers should work with their carrier to supply any requisite data if needed. Employers who sponsor self-funded health plans should coordinate with their self-funded TPA and pharmacy benefit manager to ensure timely data reporting.
Detailed information regarding the prescription drug data collection can be found on the CMS website, including the following:
- Prescription Drug Data Collection (RxDC) Reporting Instructions
- Prescription Drug Data Collection (RxDC) FAQ
