Reminder: RxDC Reporting Due June 1
Compliance News
Thursday, February 13 2025
With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should refamiliarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released, though there were no changes to the reporting requirements or data elements from last year.
As a reminder, the Consolidated Appropriations Act, 2021 includes a provision that requires group health plans and health insurance issuers (collectively “plans and issuers”) to report certain specified data related to prescription drug and other healthcare spending. The first RxDC report (for 2020 and 2021) was due on January 31, 2023, with the reports for 2022 and 2023 due on June 1, 2023, and June 1, 2024, respectively. The deadline to submit reporting for calendar year 2024 is June 1, 2025 (and continues each June 1 thereafter).
Next Steps for Employers In anticipation of the June 1, 2025, deadline, plan sponsors may receive communications from their carriers, TPAs, PBMs and other vendors regarding their expectations for completing the reporting. In our experience, carriers, TPAs, PBMs and other vendors have varying requirements and expectations of what they need from plan sponsors to successfully complete the reporting, and some may delegate some of the reporting responsibility to the plan sponsor. For example, if your insurance company, TPA or PBM sent you a survey or questionnaire to collect information about plan numbers, premium or funding types, it is likely that it is reporting the P2 and D1 files on your behalf. Therefore, we recommend the following:
As a reminder, the Consolidated Appropriations Act, 2021 includes a provision that requires group health plans and health insurance issuers (collectively “plans and issuers”) to report certain specified data related to prescription drug and other healthcare spending. The first RxDC report (for 2020 and 2021) was due on January 31, 2023, with the reports for 2022 and 2023 due on June 1, 2023, and June 1, 2024, respectively. The deadline to submit reporting for calendar year 2024 is June 1, 2025 (and continues each June 1 thereafter).
Next Steps for Employers In anticipation of the June 1, 2025, deadline, plan sponsors may receive communications from their carriers, TPAs, PBMs and other vendors regarding their expectations for completing the reporting. In our experience, carriers, TPAs, PBMs and other vendors have varying requirements and expectations of what they need from plan sponsors to successfully complete the reporting, and some may delegate some of the reporting responsibility to the plan sponsor. For example, if your insurance company, TPA or PBM sent you a survey or questionnaire to collect information about plan numbers, premium or funding types, it is likely that it is reporting the P2 and D1 files on your behalf. Therefore, we recommend the following:
- Respond to any requests for information you may receive, and coordinate with your vendors to understand their expectations to ensure all reporting is completed in full on behalf of the plan. Note: Some carriers require responses by early March.
- If your vendor sent you an email or letter asking you to create an HIOS account or stating that it will not submit P2 and D1 on your behalf, that means you must submit P2 and D1 directly to the Centers for Medicare & Medicaid Services (CMS) or engage a third-party to submit them for you. Thus, you and/or a third party submitting P2 or D1 on your behalf will need to follow the RxDC Reporting Instructions and timely complete the submission.