RxDC Reporting Deadline

Group health plan sponsors and health insurance issuers are required to submit an annual prescription drug data collection report (“RxDC reporting”) to the Centers for Medicare and Medicaid Services (“CMS”), detailing certain prescription drug benefits and other health care spending data respective of the group health plans they sponsor. Respecting the 2023 calendar year reporting cycle, these informational disclosures must be provided to CMS on or before Saturday, June 1, 2024.

Employer Action Items

As of the date of receipt of this BRCC Alert, if you have not received RxDC reporting-related communications from your health insurance carriers, third-party administrator (“TPA”), or your pharmacy benefit manager (“PBM”), please consider the following actions:

• Contact your vendors. Identify whether and to what extent your vendors may require additional information from you to perform the federal reporting obligations on a timely basis. Many carriers, TPAs, and PBMs have either voluntarily or contractually agreed to make these disclosures on behalf of the employer-sponsored plans they insure and/or administer.
• Review your written agreements. The vendor agreements maintained with your vendors should contemplate the performance of the RxDC reporting obligations. If your written agreements are silent respecting the performance of these obligations, time is of the essence to ensure that your carriers and administrators will prepare and submit these disclosures on your behalf.
• Provide Plan-specific Information to your Vendors. Your vendors may require additional plan or enrollee-specific information (such as group health plan premiums, prescription drug pricing, and participant enrollment data) in order to perform the RxDC reporting obligations. In many instances, vendors are emailing informational surveys to employers requesting this information. Closely monitor your email for the arrival of these important vendor surveys and upon receipt of any vendor survey or informational request, respond on an accurate and timely basis.

Note: Employers with self-funded plans should confirm their TPA or PBM (as relevant) is preparing and submitting these disclosures, because ultimately, it is the employer plan sponsor who is charged to assure compliance with the RxDC reporting obligations.

Regulatory Overview

Summary of Requirements:

“Under Section 204 (of Title II, Division BB) of the [Consolidated Appropriations Act, 2021], insurance companies and employer-based health plans must submit information about prescription drugs and health care spending. This data submission is called the RxDC report. The Rx stands for prescription drug and the DC stands for data collection. The RxDC report isn’t only about prescription drugs. It also collects information about spending on health care services and premium paid by members and employers.

The RxDC report is comprised of several files, including those that require specific plan-level information (such as plan year beginning and end dates as well as enrollment and premium data) and detailed information about pharmacy and medical benefits.

Most employers contract with third parties, such as issuers, third-party administrators (TPAs) and pharmacy benefit managers (PBMs), to submit RxDC reports on behalf of their health plans. Employers may even work with multiple third parties to complete the RxDC report for their health plans. CMS will consider a health plan’s submission complete if it receives all required files, regardless of who or what entity submits them.”

Primary Filing Resources:

• https://www.cms.gov/marketplace/about/oversight/other-insurance-protections/prescription-drug-data-collection-rxdc
• RxDC reporting instructions (PDF)
• RxDC templates and data dictionary (ZIP)
• RxDC drug name and therapeutic class crosswalk (XLSX)
• RxDC data validations (XLSX)

Additional Employer Resources:

• Frequently Asked Questions (PDF)
• Training Resource Directory (PDF)
• RxDC YouTube Playlist
• Federal Regulation

More Information

For questions regarding this Legislative Update or any other related compliance issues, please contact your Burnham Benefits Consultant or Burnham Benefits at 949‐833‐2983 or inquiries@burnhambenefits.com.

This Legislative Update was prepared by the Baldwin Regulatory Compliance Collaborative (the “BRCC”), a partnership of compliance professionals offering client support and compliance solutions for the benefit of the Baldwin Risk Partners organization, which includes: Jason Sheffield, BRP National Director of Compliance; Richard Asensio, Burnham Benefits Insurance Services; Nicole L. Fender, the Capital Group; Bill Freeman, AHT Insurance; Stephanie Hall, RBA/TBA; Caitlin Hillenbrand, AHT Insurance; Paul Van Brunt, Baldwin Krystyn Sherman Partners (BKS); and Natashia Wright, Insgroup.

Burnham Benefits and the BRCC do not engage in the practice of law and this publication should not be construed as the providing of legal advice or a legal opinion of any kind. The consulting advice we provide is intended solely to assist in assessing its compliance with applicable federal and state law requirements, and is based on our interpretation of federal guidance in effect as of the date of this publication. To the best of our knowledge, the information provided herein, and assumptions relied on, are reasonable and accurate as of the date of this publication. Furthermore, to ensure compliance with IRS Circular 230, any tax advice contained in this publication is not intended to be used, and cannot be used, for purposes of (i) avoiding penalties imposed under the United States Internal Revenue Code or (ii) promoting, marketing or recommending to another person any tax-related matter.