On Friday, December 23, 2022, the Departments of Labor, Health & Human Services, and the Treasury (collectively, the “Departments”) announced that the Prescription Drug Data Collection (RxDC) reporting deadline for reference years 2020 and 2021 will be further delayed until January 31, 2023. You may recall that health plans and health insurance issuers were to submit the first round of RxDC filings to the Centers for Medicare & Medicaid Services (CMS), via its website, by no later than December 27, 2022 – which, itself, was a delayed deadline.

In a Frequently Asked Question (FAQ) regarding implementation of certain provisions of the Consolidated Appropriations Act, 2021 (CAA), the Departments also announced a non-enforcement grace period for any health plan or issuer that uses a good faith, reasonable interpretation to make their 2020 and 2021 filings in accordance with the new deadline. This is welcome news in light of the significant operational challenges encountered by plans and issuers in complying with this new reporting requirement, particularly in coordinating the submission of data across multiple reporting entities.

The Departments have also provided additional flexibility in the reporting structure, which should alleviate some of the coordination issues faced by plans and issuers in this first filing. These temporary changes (e.g., permitted for 2020 and 2021 filings only) to the reporting instructions include:

  • Allowing multiple RxDC submissions by the same reporting entity;
  • Allowing more than one reporting entity to submit the same data file type on behalf of the same plan or issuer;
  • Suspending the aggregation restriction for the D2 file where multiple reporting entities are submitting on behalf of a plan or issuer;
  • Allowing group health plans to submit premium and life-years data (P2, D1, and a Narrative File) by direct email to CMS (RxDCsubmissions@cms.hhs.gov);
  • Making reporting on vaccines optional; and
  • Making reporting amounts not applied to the deductible and out-of-pocket maximum optional.

MJ’s Compliance Team has been working diligently to ensure that our clients’ plans meet this new reporting requirement. We have been working with our clients’ insurance carriers, third party administrators (TPAs), and pharmacy benefit managers (PBMs) to coordinate submission of the required data. Despite the delayed deadline, most vendors have already submitted their RxDC filings to CMS. Nevertheless, we will continue to update you as new information is made available.

Please reach out to your MJ representative if you have any questions or concerns about whether your group health plan is in compliance with these rules.