Prescription Drug Data Collection(RxDC)
Insurance companies and employer-based health plans must submit information about prescription drugs and health care spending. This data submission is called the RxDC report.
The RxDC report isn't only about prescription drugs. It also collects information about spending on health care services and premiums paid by members and employers.
The Centers for Medicare and Medicaid Services (CMS) collects the RxDC report on behalf of the Department of Health and Human Services, the Department of Labor, the Department of Treasury, and the Office of Personnel Management.
The information is used to:
Who is required to file?
It is imperative that the plan sponsor completes any survey, request for information, or other data gathering by the carrier. The carrier will file an incomplete report if the plan sponsor fails to respond to the data request. Ultimately, it is the group health plan sponsor’s responsibility to ensure a complete filing. If an incomplete report is filed, the group health plan sponsor must complete the missing reports and file with the Centers for Medicare & Medicaid Services (CMS).
Note: Filings are not required for account-based plans (such as Heath Reimbursement Arrangements) or excepted benefit plans (like dental or vision plans, or short-term limited duration plans).
RxDC Compliance
The RxDC report isn't only about prescription drugs. It also collects information about spending on health care services and premiums paid by members and employers.
The Centers for Medicare and Medicaid Services (CMS) collects the RxDC report on behalf of the Department of Health and Human Services, the Department of Labor, the Department of Treasury, and the Office of Personnel Management.
The information is used to:
- Identify major drivers of increases in prescription drug and health care spending
- Understand how prescription drug rebates impact premiums and out-of-pocket costs
- Promote transparency in prescription drug pricing
- It depends on your carrier.
- Some carriers have sent out a survey, asking for specific information.
- If you have received that survey, complete it ASAP!
- If you meet the carrier survey in time, then you likely have nothing else to do.
Who is required to file?
- Group health medical carriers must file the RxDC report as an insurance issuer. Group health plan sponsors are required to ensure that a complete filing is done.
- Medical carriers, TPAs, PBMs, and other vendors may file the RxDC reporting on behalf of plan sponsors.
- Check with the carrier, TPA, PBM, and other vendors to determine if they are filing on behalf of the plan, what additional information is needed to make a complete filing, and if they will charge a fee to do so. In the event the TPA, PBM, or other vendors do not file on the client’s behalf (employer-based plan, multi-employer plan, etc.), then the plan sponsor is required to file the RxDC reporting. See the steps on page 2 for instructions.
- Health plan carriers must file on behalf of the group health plan sponsor but may need additional information to complete the filing.
It is imperative that the plan sponsor completes any survey, request for information, or other data gathering by the carrier. The carrier will file an incomplete report if the plan sponsor fails to respond to the data request. Ultimately, it is the group health plan sponsor’s responsibility to ensure a complete filing. If an incomplete report is filed, the group health plan sponsor must complete the missing reports and file with the Centers for Medicare & Medicaid Services (CMS).
Note: Filings are not required for account-based plans (such as Heath Reimbursement Arrangements) or excepted benefit plans (like dental or vision plans, or short-term limited duration plans).
RxDC Compliance
- Deadline is June 1
- $100 per day per violation if you don’t file
- Annual requirement
