As you may recall, the Consolidated Appropriations Act of 2021 (CAA) requires group health plans to submit to the Centers for Medicare & Medicaid Services information about prescription drugs and health care spending. This data submission is called RxDC (for Prescription Drug Data Collection)… and if you are a MedBen client, we will prepare and file the RxDC report on your behalf.
The RxDC report isn’t only about prescription drugs. It also collects information about prescription drug pricing trends, reimbursement amounts including rebates, health plan enrollment, participant out-of-pocket costs, and total spending on health care services broken down by hospital costs, and provider and clinical service costs for primary and specialty care.
Group health plans required to report include both grandfathered and non-grandfathered plans, self-funded plans, non-federal governmental plans, and church plans. Plan sponsors have the ultimate responsibility for reporting, but third parties like third-party administrators (TPAs) and pharmacy benefit managers (PBMs) can report on behalf of their clients. And MedBen is ready to do just that.
In the next week, MedBen clients will receive information about the reporting requirement and the information we need from plan sponsors to complete the report. All plans must report the required RxDC data using a federal portal available online through HIOS no later than June 1, 2025.
For more information about RxDC reporting, please contact your Account Management team or Director of Compliance & Human Resources Erin Kelly.