The U.S. Department of Health and Human Services (“HHS”) has released revised instructions for group health plans and insurers to report prescription drug and health care (RxDC) spending data, as required by the Consolidated Appropriations Act, 2021 (see our prior Update). The first round of reporting (for 2020 and 2021) was due December 27, 2022, with reporting due by June 1 for each year thereafter. As background, plans and insurers must submit annual spending, premium, and enrollment information based on the “reference year” (i.e., the calendar year immediately preceding the calendar year in which the data submission is due). Reporting instructions were previously released for the 2020 and 2021 reference years. The newly released reporting instructions are for the 2022 reference year. The upcoming deadline for submission of the 2022 reference year report is June 1, 2023.
The newly released instructions provide step-by-step guidance for submitting data through the RxDC module in the Health Insurance Oversight System (HIOS). The instructions address who must report and when and include detailed explanations of spending categories and data aggregation rules. Among other things, the 2022 reporting instructions have been revised to allow multiple vendors to submit data files on behalf of the same plan or insurer. They also address suspended data aggregation restrictions and provide additional guidance on reporting prescription drug rebates.
Submission of Information for June 1, 2023
For June 2023 reporting, we expect that all group health plan sponsors will have some role to play in the RxDC reporting process, regardless of their size and whether they are fully insured or self-insured. This is because of a change in what information is required to be reported starting June 1, 2023. The RxDC reporting requirement takes the form of nine different data files:
D1: Plan details (vendors, number of covered individuals, premiums, etc.)
D2: Medical spending information
D3-D8: Drug spending information
P2: Plan identifying information (like a cover sheet to the accompanying D files identifying which plans are included)
Much of the needed data is in the possession of the carriers/TPAs/PBMs so they can handle the filing of those reports without the employer’s input or assistance. But most carriers/TPAs/PBMs do not collect and store an individual group’s premium contribution split (for the D1 reporting), which means they have to obtain this information from the employer. For December 2022 submissions, reporting this data was optional so employer involvement was minimal. For June 2023 and subsequent reporting, this data is required, which means employers will have to supply this information. Some carriers/TPAs/PBMs will collect/report this data and will require that the employer provide the data to them by a specific date. A few carriers/TPAs/PBMs will not file the D1 and the employer will be responsible for submitting that file on its own. In this case the employer will have to register with HIOS (see HIOS User Manual and Guide and HIOS Portal Quick Guide for step-by-step instructions) and prepare a P2 and D1 file to submit by June 1, 2023.
As compliance related questions and issues continue to surface from vendors and employers, we are hopeful that the vendor industry will continue to evolve their processes to provide maximum assistance to the employer community and also that HHS will continue to provide further guidance, clarifications, and support as we approach the next June reporting deadline. HHS recognizes the practical filing considerations and continues to address the administrative burdens to comply for employers and the industry.
Conner Strong & Buckelew is working directly with carriers/TPAs/ PBMs and others to monitor guidance and confirm vendor approaches to assist our clients in remaining compliant with these RxDC requirements. We will provide alerts and updates as new information becomes available. Please contact your Conner Strong & Buckelew account representative toll-free at 1-877-861-3220 with any questions. For a complete list of Legislative Updates issued by Conner Strong & Buckelew, visit our online Resource Center.