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Time to Prepare for 2024 RxDC Reporting

annual report papers on desk with eyeglasses

1 minute read

Group health plans and issuers must submit detailed data on prescription drug and health care spending annually to the Centers for Medicare & Medicaid Services (CMS). Known as the RxDC report, the next deadline is June 1, 2024, for 2023 data.

This report includes plan-level details, enrollment data, and information on medical and pharmacy benefits. Employers typically engage third parties like third-party administrators (TPAs) and pharmacy benefit managers (PBMs) to handle RxDC submissions, ensuring CMS receives all necessary files for completion.

 

Action Steps

Employers should proactively engage with their issuers, TPAs, or PBMs to ensure the timely submission of RxDC files for their health plans by June 1, 2024. It is essential for employers to verify that their contractual agreements with these third parties explicitly cover this reporting obligation.

Additionally, employers may be required to furnish their third-party vendors with plan-specific details, such as enrollment and premium data, to facilitate the completion of their RxDC submission. Employers should be vigilant for any vendor surveys and promptly furnish the necessary information. Given that employers with self-funded plans bear the ultimate responsibility for RxDC reporting, they should diligently oversee their TPAs' or PBMs' adherence to this reporting mandate. Download the bulletin for more details.

 

Additional Resources

RxDC reporting webpage (with links to reporting resources)

FAQs

Reporting instructions (updated January 2024)

User Manual for submitting RxDC reports

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National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.

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Steve Smith

Steve Smith

Steve Smith is a powerhouse of energy, living by the mantra "work hard, play hard." As an expert in uniting teams for a greater purpose, Steve's innovative and creative strategies in employee health and wellness are game-changers. With over 25 years of expertise in health insurance, covering compliance, cost mitigation, utilization, analytics, wellness plans, and strategic planning, Steve is the go-to expert for driving down utilization trends and fostering a culture of well-being. His clients trust him to deliver exceptional results, making him an invaluable asset in the industry. As an Employee Benefits Consultant, Steve specializes in health care consulting for Minnesota public sector organizations including fully insured, self-insured, and stop-loss plans. Steve is a licensed insurance agent and holds the designations for Managed Healthcare Professional (The Health Insurance Association of America), Certified Patient Protection and Affordable Care Act Professional (National Association of Health Underwriters), and Group Benefits Disability Specialist (Hartford School of Insurance).