Due to a provision in the Consolidated Appropriations Act of 2021 (CAA), groups are now required to report prescription drug benefits, drug costs, and healthcare spending annually. The first Prescription Drug Data Collection (RxDC) report will need to be submitted to Centers for Medicare and Medicaid Services (CMS) no later than December 27, 2022. This report should include data from 2020 and 2021. Future reports will be due annually on June 1st.
EMI Health is working on your behalf to submit all of the reporting explained below—so no action is required on your part. But by way of notification—we are writing this to inform you that you are compliant with the following:
Those required to submit the RxDC report include:
- Health insurance issuers offering group coverage.
- Health insurance issuers offering individual market coverage.
- Fully-insured and self-funded group health plans.
Employer-based health plans are required to 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.
- Premiums and cost-sharing that patients pay.
Health plan sponsors (e.g., employers) are required to submit their data through the RxDC module in CMS’s Health Insurance Oversight System (“HIOS”) on the CMS website, unless they confirm that their Pharmacy Benefit Manager (“PBM”), Third Party Administrator (“TPA”), or another third-party entity will be submitting the RxDC report on their behalf.
To submit a report, healthcare plan sponsors will need to create a HIOS account. NOTE: The registration process can take up to two weeks. To create a HIOS account, go to CMS’s Enterprise Portal at https://portal.cms.gov/portal/ and click the “New User Registration” button. At the “Select Your Application” screen, scroll down to select “HIOS.” Additional details are included in the HIOS Portal User Manual athttps://regtap.cms.gov/reg_librarye.php?&i=3989.
For assistance, contact the Registration for Technical Assistance Portal (“REGTAP”) help desk at 1-855-267-1515 or CMS_FEPS@cms.hhs.gov. Include “RxDC” in the body of the email for faster service. REGTAP has advised that initial responses to help desk inquiries are typically sent the same day, but a full resolution could take one to two weeks.
For additional details, instructions, templates, and answers to frequently-asked questions, see CMS RxDC Resources.
As stated prior, no effort will need to be made on your part for the submission. EMI Health will complete all the required items on your behalf.