Compliance Corner: Looming Carrier Deadlines for RxDC Reporting
Beginning last year, many insurance companies now send out client surveys to collect information that is needed to complete government RxDC reporting on behalf of employers.
Nearly all insurance companies have client surveys out to employers at this time.
The deadlines for clients who were covered by these insurers as of December 31, 2023:
- Aetna is sending emails to clients the week of March 11 to request data
- Anthem’s deadline is March 15, 2024
- Humana’s deadline is April 1, 2024
- Medical Mutual of Ohio (MMO)’s deadline was March 1, 2024
- UnitedHealthcare’s deadline is April 10, 2024
If carriers don’t receive this information from employers, the employers are then responsible for submitting the missing information personally to CMS. We know from past experience that this can be time consuming and difficult.
What is the reporting requirement?
Under the Consolidated Appropriations Act of 2021, health insurers, fully insured, and self-funded group health plans are required to provide prescription drug and health spending data annually to the Departments of Health and Human Services, Labor, and Treasury via the Centers for Medicare and Medicaid Services (CMS). However, some of the information is not readily available to some insurers who handle the bulk of data reporting.
What information is requested?
These are the common data elements requested:
- Group health plan name. The name used to identify the plan name for employees and their dependents. If multiple plans, include the names of all.
- Plan sponsor/employer name and contact information
- Plan sponsor/employer tax identification number (also called EIN or Employer Identification Number)
- Average monthly premium paid or percentage paid by employers versus employees.
For more information on the information requested by the government, please click here and review pages 30 to 34 of the CMS RxDC Report Instructions for more details.
If you would like help completing these forms…
Your ARC client advisor will be in touch to assist with this request. If you’re ready to get started, please connect with your ARC client advisor as we may need some additional information from you.
