CMS Updates Prescription Drug Data Collection (RxDC) Reporting Instructions for 2022 Reference Year

The Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have updated Prescription Drug Data Collection (RxDC) reporting instructions for the 2022 reference year. The reference year is the calendar year immediately preceding the calendar year in which the RxDC report is due. The RxDC report for the 2022 reference year, which is due in 2023, should contain information based on what happened in calendar year 2022. 

The RxDC report also collects information on total spending on health care services, including health care premium, enrollment, and spending broken down by hospital costs, provider and clinical service costs for primary and specialty care (separately), and other medical costs, including wellness services.

Page 3 lists 15 significant changes to the instructions from the prior year. Highlights of changes include:

• Reporting does not apply to retiree-only plans.
• Added specifications for prescription drug rebates and stop-loss reimbursements
• Added option for multiple vendors to submit the same data file on behalf of the same plan, issuer, or carrier.  
• Added option for a reporting entity to create multiple submissions in the Health Insurance Oversight System (HIOS)
  for the same reference year. 
  
• Renamed columns in data files and rearranged plan list instructions.
  
  

The deadline for the 2022 reference year report is June 1, 2023.

(Posted March 29, 2023)

Federal Employees Health Benefits (FEHB) Carrier RxDC Reporting 

Centers for Medicare & Medicaid Services, Health and Human Services (HHS) have published an information collection request to revise a currently approved collection titled, "Prescription Drug and Health Care Spending."

On December 27, 2020, the Consolidated Appropriations Act, 2021 (CAA) was signed into law. The 2021 interim final rules, "Prescription Drug and Health Care Spending," issued by the Department of the Treasury, the Department of Labor (DOL), the Department of Health and Human Services (HHS) and the Office of Personnel Management (OPM) implement the provisions of section 9825 of the Code, section 725 of ERISA, and section 2799A-10 of the PHS Act, as enacted by section 204 of Title II of Division BB of the CAA. OPM joined the Departments in issuing the 2021 interim final rules, requiring Federal Employees Health Benefits (FEHB) carriers to report information about prescription drug and health care spending, premiums, and plan enrollment in the same manner as a group health plan or health insurance issuer offering group or individual health insurance coverage.

Comments regarding are FEHB carrier reporting are due May 26, 2023.