Keenan Briefings

Briefing

Rx Data Collection Q&A

In recent weeks, many health insurance carriers have sent out communications to employers seeking specific information regarding their plans. Many of these carriers are imposing deadlines in March or April. These requests, and the short and conflicting deadlines have led to some concern and confusion on the part of many employers.

Q1: What information are they asking for?

Answer: Carriers are asking for a variety of data points, including:

• average monthly premiums paid by the employer
• the premium share paid by employees
• Self-funded administration fee/TPA fee (if applicable)
• Medical, pharmacy, behavioral, wellness, stop loss vendors and their Employee Identification Number (EIN)

Q2: Why are carriers requesting this?

Answer: These requests are being made in connection with carriers’ preparations to comply with Section 204 reporting in June. This reporting is referred to by CMS as “Rx Data Collection,” or RxDC, but in reality it required the reporting of much more data than that solely relevant to health plans’ prescription drug spending. Section 204 of the Consolidated Appropriations Act of 2021 (CAA) requires insurance carriers and self-insured health plans to submit information to the federal government about spending on medical treatment, which includes spending on prescription drugs as well as amounts spent on other medical costs, premiums and cost-sharing.

Q3: Didn’t we just finish this reporting?

This requirement technically went into effect as of calendar year 2020, but initial compliance was delayed twice. In January, carriers and plans submitted the first sets of data, for calendar years 2020 and 2021. Reporting for calendar year 2022 will be due on June 1, 2023, and will continue annually every June 1 thereafter.

Q4: Why weren’t employers asked to provide this information last year?

Answer: CMS allowed some leeway in reporting the data for 2020 and 2021. In FAQ guidance released on December 23, 2022, the Departments stated that they would not take enforcement action with respect to any plan or issuer that uses a good faith, reasonable interpretation of the then-available RxDC regulations and Reporting Instructions. Certain other reporting categories were made optional for the 2020 and 2021 data submissions, including reporting on vaccines, and amounts not applied to the deductible or out-of-pocket maximum.

CMS is still working on reporting instructions for the 2022 calendar year reporting due this June.

Q5: How should our plan respond to TPA or carrier requests?

Answer: Employers should make their best efforts to comply with carrier requests in a timely manner, understanding that carrier and TPA requests may change as CMS releases Reporting Instructions and other guidance. For now, carrier requests are based on the Reporting Instructions for 2020 and 2021.

Q6: How will Keenan assist fully insured and self-funded plans to comply with these requests?

Answer: Both the reporting obligation and the information necessary to complete the carrier requests are held by each employer. Keenan will assist fully insured clients that have questions about the process. For self-funded plans that are administered by the Keenan TPA, further communications will be forthcoming regarding information needed for the TPA to complete your 2022 filing by the June 1, 2023 deadline.

AP Keenan is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Clients 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 clients’ business activities.