As a Christmas present to everyone struggling with last minute preparations to submit RxDC reporting by the December 27th due date, the Departments of Labor, HHS, and Treasury (the “Departments”) issued a new FAQ providing reporting relief for the 2020 and 2021 reference years. Specifically, the Departments indicated that:
- They will provide a submission grace period for the first reports originally due December27, 2022. Reports will not be considered out of compliance as long as they are submitted prior to the grace period ending January 31, 2023.
- They will not take enforcement action against any plan or issuer (insurer) that has made a good faith effort to reasonably interpret the regulations and RxDC Reporting Instructions in making its submission.
What this Means
If you are reporting on behalf of a self-funded plan and are facing challenges in reporting, there is a little more time to work through some of those issues. (e.g. you are trying to resolve error codes in making a submission, you have learned that a vendor is not reporting as expected, etc.) If you are fully insured or your vendor or vendors have indicated that they will report and confirmed their submission, no action should be necessary.
Certain Reporting Requirements Also Relaxed
In addition to extension of the reporting deadline and good faith effort relief mentioned above, certain restrictions in the reporting rules have been relaxed for the 2020 and 2021 reference years. Most of the accommodations are more applicable to the vendor submitting the report, but the relief is none the less important for plans to understand (especially self-funded plans):
- The requirement that only one data file may be submitted per plan. Initially, the rules required that multiple reporting entities work together to submit a single data file. Under the relief, multiple reporting entities may submit a data file on behalf of a plan. (e.g. a claims administrator may submit a data file for drugs dispensed through the medical component plan and a pharmacy administrator may submit the same data file for claims paid through the PBM)
- The requirement that all reporting entities aggregate data to the same level (i.e. data may be aggregated by state and or market segment by one reporting entity, but not aggregated at all by another if multiple vendors are reporting)
- The requirement that each reporting entity make only one submission. Reporting entities if filing on behalf of multiple plans or issuers for a single reference year may make more than one submission.
- Premium and life years data (D1) may be submitted via email for certain plans. If a group health plan or its reporting entity is submitting only the plan list, premium and life-years data, and narrative response and is not submitting any other data, it may submit the file by email to RxDCsubmissions@cms.hhs.gov instead of submitting in HIOS.
- Reporting on vaccines is optional. The CMS drug name and therapeutic class crosswalk was updated on October 3, 2022, to include National Drug Codes (NDCs) for vaccines. Vaccines may be reported but are not required to be reported.
- Reporting of amounts not applied to the deductible or out of pocket maximum is optional. Values for “Amounts not applied to the deductible or out-of-pocket maximum” and the “Rx Amounts not applied to the deductible or out-of-pocket maximum” are not required to be reported. A reporting entity should not remove these columns from data files D2 and D6 but may leave the data fields in these columns blank.
If you would like to read the full FAQ issued by the Departments, it is available here.
If you have questions or need assistance, please contact your HORAN representative at 800.544.8306.
The information contained in this document is informational only and is not intended as, nor should it be construed as, legal or accounting advice. Neither HORAN nor its consultants provide legal, tax nor accounting advice of any kind. We make no legal representation, nor do we take legal responsibility of any kind regarding regulatory compliance. Please consult your counsel for a definitive interpretation of current statute and regulation and their impact on you and your organization.