UHC 2024 RxDC Reporting Update
Customers must complete the RFI no later than March 31, 2025. This deadline is firm.
Under the Consolidated Appropriations Act (CAA), health insurers offering group or individual health coverage and self-funded group health plans are required to report data annually regarding prescription drugs and health care spending to the Departments of Health and Human Services, Labor, and Treasury (Tri-Agencies). June 1, 2025, is the required submission date to report 2024 data through a web portal set up by the Centers for Medicare & Medicaid Services (CMS). However, please note, that UHC is requesting customers complete the RFI tool located on the UHC employer/broker portal (uhceservices.com, Employer eServices and All Savers) by March 31, 2025, in order for UHC to aggregate and submit the data to CMS by the June 1, 2025, deadline.
UnitedHealthcare approach and support
Each year, UnitedHealthcare submits the P2 (Group Health Plan), D1 (Premium and Life Years) and D2 (Spending by Category) files for all fully insured, Level Funded/Alternate Funded and self-funded customers who had active coverage with UnitedHealthcare or its affiliates (such as UMR, Surest) during the reference year. For the upcoming submission on June 1, 2025, the reference year is 2024.
For employers who have an OptumRx integrated PBM, UnitedHealthcare will also submit the D3-D8 files. However, for employers using any other PBM, including OptumRx Direct, they must coordinate with their PBM to submit the appropriate files.
It is important for you to complete the RFI by the March 31 deadline. To save time, UHC recommends using the UHC RxDC RFI worksheet to gather the required data in advance. Links to the worksheet are also in the RxDC Brainshark video and in the RxDC FAQs.
As noted earlier, the deadline for you or your designer to answer the questions in the UHC RFI or emailed UMR RFI is March 31, 2025. All responses must be completed and attested for UnitedHealthcare to submit the data to CMS. Partial or incomplete information will not be included.
If the RFI is not completed and submitted by the March 31 deadline, UnitedHealthcare will submit to CMS only the data available in their system for the 2024 reference year. However, this submission will be considered incomplete, and you will be responsible for any missing reporting data.
- Any data elements (P2 or D1) not provided to UnitedHealthcare will need to be submitted directly to CMS by your health plan or another reporting entity.
- The employer accepts the risk and responsibility associated with not providing the requested information to UnitedHealthcare for the RxDC data submission.
If you are a self-funded customer that plans to submit your data to CMS, please contact your UnitedHealthcare representative no later than March 31, 2025. UHC will provide the data they have to support your submission by mid-May. Note: This option is not available for fully insured employers and not recommended for Level Funded.
References:
- UHC RxDC Guide
- UHC RxDC Brainshark
- UHC RxDC RFI Worksheet
- UHC RxDC FAQs
- UHC Pharmacy Benefits and Costs Reporting webpage
- CMS RxDC webpage
- CMS RxDC - Reporting Instructions
If you have any questions or require further assistance, please contact your UnitedHealthcare representative.