January 30, 2024
The Consolidated Appropriations Act, 2021, requires insurers and group health plans to report health care costs each year to the Centers for Medicare & Medicaid Services (CMS). Known as Prescription Drug Data Collection (RxDC), reporting includes the top drivers of health care spending, including prescription drug costs, health plan premium, administrative fees for self-funded employer groups and stop-loss.
We supported groups’ 2021 and 2022 RxDC reporting, submitting data for the benefits we administered in 2021-22 on behalf of all fully insured groups, as well as self-funded groups that authorized us to do so. Our systems held all the data needed for reporting for fully insured groups; however, reporting for self-funded groups required us to manually collect certain data from groups we didn’t hold. Some self-funded groups opted to submit their reporting through another entity.
Submitting 2023 RxDC reporting will again require us to collect data that’s not in our systems from employer groups. To enable you to share the needed data, we’re implementing a self-reporting form that will be accessible through Employer Center. Here’s what data we’ll need to collect to fulfill RxDC reporting on your behalf:
- Fully insured groups will be required to provide the dollar amount of premium they collected from all enrolled employees in 2023.
- Self-funded groups will be required to provide us the same data they provided for 2021-22: Premium equivalents, and a D1 (premium and life years) file for the benefits we administered in 2023.
Employer groups that don’t submit their required reporting data and, if self-funded, reporting authorization to us by April 30, 2024, won’t be included in our 2023 RxDC submission to CMS. These groups will need to submit their reporting independently or through another entity. The RxDC reporting requirements at CMS.gov can be consulted for instructions.
We won’t submit data for benefits we don’t administer; this includes carved-out pharmacy and any premium-based benefits. Self-funded groups will need to consult with their carve-out entities on reporting of data for carved-out services.
Employer Center is our online platform used by employer group administrators to conveniently manage their benefits. If you don’t currently have access to Employer Center, visit employercenter.asuris.com and click “Request access” to get set up before the data submission deadline. Or, contact your account representative for help.
We’ll provide updates and further instructions about sending your required 2023 RxDC data to us through the self-reporting portal in the coming weeks.
Questions? Please contact your account representative.