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Group health plans and health insurance issuers must annually submit detailed information on prescription drug and health care spending to the Centers for Medicare & Medicaid Services (CMS). This reporting is referred to as the “prescription drug data collection” (or “RxDC report”). This is an annual reporting requirement; plans and issuers will generally submit these reports by June 1st each year, reporting information for the prior calendar year. This means that the next RxDC report is due by June 1, 2026 and will cover data for the 2025 calendar year
The RxDC report is comprised of several files, including those that require specific plan-level information, such as plan year beginning and end dates and enrollment and premium data. It also includes files that require detailed information about medical and pharmacy benefits.
Most employers contract with third parties, such as issuers, third-party administrators (TPAs) and pharmacy benefit managers (PBMs), to submit RxDC reports on behalf of their health plans. Employers may work with multiple third parties to complete the RxDC report for their health plans. For example, a self-insured employer may use both its TPA and PBM to submit different portions of the RxDC report. A health plan’s submission is considered complete if CMS receives all required files, regardless of who submits them.
For questions and to verify reporting responsibility and information needed, please contact your carrier, TPA or PBM or feel free to reach out to your Lawley Account Executive.
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Since joining Lawley in March 2010 as a compliance specialist, Judy has been instrumental in enhancing client services by focusing on the complexities of new legislation and compliance requirements. In her role, she collaborates closely with benefits consultants and account executives to equip clients with the tools, resources, and guidance they need to stay compliant in an everchanging regulatory landscape.