QUESTION: We’ve heard that the requirement to report prescription drug and well being care spending to the federal government has been delayed. What are the reporting necessities and when are the experiences due?

ANSWER: Laws handed in 2020 requires group well being plans and insurers to yearly report prescription drug and well being care spending, premiums, and enrollment data to the federal government (see our Checkpoint article). Along with normal figuring out data equivalent to the start and finish dates of the plan yr, the variety of enrollees coated, and every state wherein the plan is obtainable, a broad vary of well being care spending data should be reported (see our Checkpoint article). For instance, the common month-to-month premium paid by workers versus employers should be reported, in addition to the full well being care spending damaged down by kind (equivalent to hospital care, major care, and specialty care) and prescription drug spending by enrollees versus plans and insurers. Plans and insurers should additionally report the 50 most incessantly allotted model pharmaceuticals, the 50 costliest pharmaceuticals by whole annual spending, and the 50 pharmaceuticals with the best enhance in plan or protection expenditures from the earlier yr. HHS has launched information submission directions that assessment who should report and clarify easy methods to submit the info by the RxDC module within the Well being Insurance coverage Oversight System (HIOS) (see our Checkpoint article).

Data should be submitted primarily based on the “reference yr,” which the companies have outlined because the calendar yr instantly previous the calendar yr wherein the info submission is due. Calendar yr 2020 data was initially required to be submitted by December 27, 2021; calendar yr 2021 data by June 1, 2022; calendar yr 2022 data by June 1, 2023; and so forth. Nonetheless, the companies suggested that they might not provoke enforcement actions towards plans or insurers that submitted the required information for the 2020 and 2021 reference years by December 27, 2022. In December 2022, reporting for these years was delayed once more till January 31, 2023. The companies won’t take enforcement motion with respect to any plan or insurer that submits on or earlier than that date, utilizing a superb religion, cheap interpretation of the laws and the RxDC reporting directions. A number of clarifications and reporting flexibilities had been additionally offered (see our Checkpoint article). The deadline for reporting 2022 information stays June 1, 2023.

For extra data, see EBIA’s Well being Care Reform handbook at Part XXXVI.L (“Prescription Drug and Well being Care Spending Reporting”). See additionally EBIA’s Self-Insured Well being Plans handbook at Part XXIX.D.4 (“Prescription Drug and Well being Care Spending”) and EBIA’s ERISA Compliance handbook at Part XXI.C (“Warning Relating to Extra Obligations”).

Contributing Editors: EBIA Employees.