Employee Benefits Market Check Survey: Prescription Drug Reporting Requirements

In 2021, Congress passed the Consolidated Appropriations Act (CAA). Within that bill came several provisions that impacted employee benefit plans. The latest provision set to take effect is the prescription drug reporting requirement. The goal of the prescription drug requirement was to collect data on drug costs with the hopes the additional information would increase transparency and reduce Rx costs long term.

The first reports are due December 27, 2022, and must provide Rx data for the calendar years 2020 and 2021. Reporting will be annual after that, by June 1 of the following year. While the intent of the regulation may be well-intentioned, the reality is employers and vendors are tasked with one more reporting obligation (see PCORI fee, 5500 forms, 1094/1095 forms, etc.) that makes their jobs even more demanding.

We conducted a poll during a webcast on November 17 to gain insight into employers’ concerns related to reporting. The results are in the charts below.

Key Findings
It is no surprise that over 60% of employers have some level of concern regarding the reporting requirement, and almost 60% are still unsure who is responsible for submitting their Rx data. Most employers will rely on their vendors to do some or all the reporting. However, some self-insured or level-funded employers may need to do some of the reporting themselves. Check with your carrier, TPA, or PBM to see if there will be a fee associated with the data collection and to determine what information they will submit on your behalf.

As we’ve seen with other requirements historically, these rarely go smoothly and are seldom written to make things easy on plan sponsors. The requirement is especially difficult for self-funded or level-funded employers and even more so for those with multiple vendors or recently changed vendors. For the first submission, ensuring the reports are submitted timely is more important than accuracy.

Should you have any questions or are interested in any industry-specific data, please contact your local Assurex Global adviser.