CAA Sec. 204 Prescription Drug Data Collection (RxDC)

Section 204 of the Consolidated Appropriations Act, 2021 (CAA) requires insurance companies and employer-based health plans to submit information about prescription drugs to the Centers for Medicare and Medicaid Services (CMS) on behalf of the Department of Health and Human Services, the Department of Labor, the Department of Treasury, and the Office of Personnel Management beginning December 27, 2022. These requirements are referred to as RxDC. The Rx stand for prescription drug and the DC stands for data collection.

What information do insurance companies and employers submit to CMS?

• The CAA requires insurance companies and employer-based health plans to submit information about:
• Spending on prescription drugs and health care services
• Prescription drugs that account for the most spending
• Drugs that are prescribed most frequently
• Prescription drug rebates from drug manufacturers
• Premiums and cost-sharing that patients pay

How will this information be used?

The data submitted by insurance companies and employer-based health plans will help to:

• Identify major drivers of increases in prescription drug and health care spending
• Understand how prescription drug rebates impact premiums and out-of-pocket costs
• Promote transparency in prescription drug pricing

What do these requirements mean for your groups?

Insurers, TPAs, and PBMs will control most of this information. The insurance company will likely handle all of the reporting requirements for fully insured clients, however, the carrier may need to ask the group for premium contributions in order to file. Self insured groups should work with their TPA or PBM.

Groups may want to update their contracts with the carrier. Some carriers will be submitting the required information on behalf of their fully insured clients then they will provide confirmation once reporting has been submitted.

CMS Resources:

• Prescription Drug Data Collection (RxDC) webpage
• RxDC reporting instructions (PDF)
• RxDC templates and data dictionary (ZIP)
• RxDC drug name and therapeutic class crosswalk (XLSX)
• RxDC data validations (XLSX)
• RxDC YouTube Playlist
• Regulation
• Frequently Asked Questions (PDF)

HIOS Manuals

• HIOS Portal User Manual (PDF)
• HIOS Portal RxDC Quick Reference Guide (PDF)
• RxDC HIOS Module User Manual (PDF)
• Submit your data in the CMS Enterprise Portal

For questions, please contact your B&P Sales Rep - 888.722.3373.

The information contained herein is for informational purposes only and is not intended as legal or tax advice.