Mandatory Prescription Data Collection Reporting Postponed

Posted by BAS - 12 January, 2023

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Employers, as sponsors of their group health plans, are required to report information about their plan’s prescription drug benefit utilization. Reporting is made to the US Department of Health and Human Services annually through a special online system. The first report was due by December 27, 2022 for the 2020 and 2021 calendar years and by June 1st for subsequent years. Those due dates have been postponed.

Plans must gather data including:

  • General plan sponsor information
  • Narrative information describing the impact of prescription drug rebates on premium and cost-sharing
  • Eight data files:
    • Premium/cost and life-year data
    • spending by six categories
    • top 50 most frequently dispensed brand name drugs by state and market segment
    • top 50 most costly drugs by state and market segment
    • top 50 drugs by spending increase by state and market segment
    • prescription drug spending totals
    • prescription drug rebates by therapeutic class
    • and prescription drug rebates for the top 25 drugs by state and market segment; and

Employers now have extra time to gather required data and coordinate reporting responsibilities. Employers with fully insured health plans should contact their insurer and ask if the insurer will make the required reporting. Employers with self-funded health plans should coordinate with their health coverage vendor for reporting compliance.

Topics: Company News, HR & Benefits Compliance, HR & Benefit Plans, HR & Benefits News


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