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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.
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.
RxDC reporting webpage (with links to reporting resources)
Reporting instructions (updated January 2024)
User Manual for submitting RxDC reports