What Employers Need to Know for Prescription Drug Data Collection (RxDC)

The Prescription Drug Data Collection (RxDC) program, established by the Consolidated Appropriations Act of 2021, requires insurance companies and employer-based health plans to provide details about prescription drug benefits and healthcare spending and costs to the Center for Medicare & Medicaid Services (CMS). Reporting obligations apply to both self-insured and fully-insured group health plans and reporting is due by June 1 of each year for the prior year’s coverage.

The reporting requirement is referred to as the RxDC report, where “Rx” stands for prescription drugs and “DC” signifies data collection. However, it’s important to note that the RxDC report extends beyond prescription drugs alone. It encompasses comprehensive data on healthcare service expenses as well as premiums paid by both members and employers.

In addition to information on prescription drugs, the RxDC report collects data 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.

Employers’ Responsibilities

Employers must ensure compliance with RxDC by collecting and submitting accurate information from their health plans. While insurers or TPAs may be providing the bulk of the reporting, they will need to coordinate with employers to get some employer-specific information, including company data, average monthly premium paid by the employer, average monthly premium paid by the employee. Employers will likely be contacted by their insurers/brokers/TPAs for these numbers.

BAS offers reporting through MyEnroll360 that may be helpful for collecting the required RxDC information. Self-service reports can be generated from the “Reporting” module in MyEnroll MyEnroll360 based on plan year to gather the needed premium data.

Employers should contact their insurance carrier/TPA contacts regarding the requirements for RxDC collection. For information on pulling reports for requested premium information, contact your account manager or service@basusa.com. To learn more about the reporting requirements, please refer to the RxDC Reporting Instructions provided by the CMS which is available by clicking here.