On December 23, 2022, the departments of Labor, Health and Human Services, and the Treasury issued Affordable Care Act FAQs Part 56, which provide among other things, relief for employer plan sponsors working in good faith to comply with the prescription drug and healthcare spending reporting requirement added under the Consolidated Appropriations Act, 2021 (CAA).
Specifically, starting in 2020, group health plans and health insurance issuers must report to the departments certain information, including, among other things, general information regarding the plan or coverage; the 50 most frequently dispensed brand prescription drugs, the 50 most costly prescription drugs by total annual spending and the 50 prescription drugs with the greatest increase in plan expenditures over the preceding plan year; total spending by the plan or coverage broken down by the type of costs; and the average monthly premiums paid by participants, beneficiaries and enrollees and paid by employers.
Recognizing that plans and issuers have encountered operational challenges when attempting to comply with these reporting requirements, the departments extended reporting for the 2020 and 2021 reference years to December 27, 2022. The FAQs now provide additional relief and clarifications for employer plan sponsors:
- Good faith relief. For the 2020 and 2021 data submissions that are due by December 27, 2022, the departments will not take enforcement action against any plan or issuer that uses a good faith, reasonable interpretation of the regulations and the Prescription Drug Data Collection (RxDC) Reporting Instructions in making its submission.
- Grace period. A plan or issuer now has until January 31, 2023, to make a good faith submission of 2020 and 2021 data to remain in compliance with the RxDC requirements.
- Email submission. The FAQs provide that although plans and issuers were instructed to submit information using the HIOS RxDC module, those submitting only the plan list, premium and life-years data, and narrative response — and not submitting any other data — may submit the file instead by email to RxDCsubmissions@cms.hhs.gov. The emailed submission must include the plan list file, premium and life-years data (data file D1), and a narrative response. The submission may include optional supplemental documents. The name of each file should include the reference year of the submission, the plan list or data file type (e.g., P2, D1), and the name of the group health plan sponsor.
In addition, the FAQs also clarified the following:
- More than one reporting entity may submit the same data file type on behalf of the same plan.
- A reporting entity submitting the required data may, within each state and market segment, aggregate at a less granular level than that used by the reporting entity that is submitting the total annual spending data.
- Reporting on vaccines and on amounts not applied to the deductible or out-of-pocket maximum is optional.
