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Prescription Drug Data Collection (RxDC) Resources

The RxDC reporting provision of the Consolidated Appropriations Act (CAA) requires reports on drug utilization and spending trends to be submitted to U.S. Department of Health and Human Services. Reports are due annually by June 1. 

View the Amwins Connect Health Cost Transparency Guide for Employers.

CMS Resources:

  • Prescription Drug Data Collection Reporting page
  • Prescription Drug Data Collection Reporting Instructions
  • Prescription Drug Data Collection FAQs
  • CMS RxDC HIOS Module User Manual

 

How Carriers Will Handle Reporting

CARRIERREPORTING
Fully Insured
REPORTING
Self/Level Funded
EMPLOYER SURVEYSRESOURCES
Aetna,
Banner|Aetna
Carrier will report.Carrier will report.Survey required: due by March 31, 2025
  • Aetna RxDC Overview
  • Survey Link
Allstate Benefitsn/aDetails pending for 2024Survey not required.-
AnthemCarrier will report.

Employer must report:

  • D1 Premium and Life Years report
  • Plan List
  • D3-D8 Pharmacy Specific Reports (if pharmacy coverage is not integrated)

Carrier will report:

  • P2 – Group Health Plan List
  • D2 – Spending by Category Reporting
  • D3-D8 Pharmacy Specific Reports (if integrated pharmacy coverage through CarelonRx)
  • Narrative Response applicable to Anthem business

Survey required: due by March 28, 2025

Anthem sent emails directly to the employers with information and the link to the survey.

  • Anthem RxDC Overview

     

     

Blue Cross Blue Shield of ArizonaCarrier will report.Carrier will report.Survey not required.-
Blue Shield of CaliforniaCarrier will D2 for all groups and D3-D8 for groups with prescription drug under a Blue Shield health benefit plan.Varies; refer to the Reporting Grid.

Survey required: due by April 19, 2025 

Groups or brokers with access to Employer Connection are encouraged to complete the survey at the above link.

All others can submit required information at Prescription Drug & Healthcare Spending Survey using their Group ID and the web key: #25yr24

  • Blue Shield of California RxDC Overview
  • Prescription Healthcare Spending Survey FAQs
CareFirst BCBSCarrier will report.Carrier will report.Survey required: due by May 12, 2025
  • CareFirst RxDC Overview
  • Broker Portal
  • Employer Portal
CignaCarrier will report.Carrier will report.Survey not required.-
Cigna + OscarCarrier will report.n/aSurvey not required.-
Cigna Administered by OscarCarrier will report.n/aSurvey not required.-
ConnectiCareCarrier will report.Carrier will report.

Survey required: due by May 9, 2025

ConnectiCare will email a survey link to employers in mid-April.

  • ConnectiCare RxDC Survey Notice
  • ConnectiCare CAA page
EmblemHealthCarrier will report.Carrier will report.

Survey required: due by May 9, 2025

EmblemHealth will email a survey link to employers in mid-April.

  • EmblemHealth RxDC Survey Notice
  • EmblemHealth CAA page
Florida BlueCarrier will report.Carrier will report.Survey typically required: not yet announced for 2025 -
FHCPCarrier will report.n/aSurvey typically required: not yet announced for 2025 -
Health NetCarrier will report.n/aSurvey not required.
  • Health Net RxDC overview
HealthfirstCarrier will report.Carrier will report.Survey not required.-
Kaiser PermanenteCarrier will report.Carrier will report.Survey required: survey will be available until March 31, 2025
  • Kaiser RxDC overview
Sharp Health PlanCarrier will report.n/aSurvey required: due by April 18, 2025
  • Sharp RxDC overview
  • Survey Link
  • RxDC FAQs
Sutter Health PlusCarrier will report.n/aSurvey required: due by March 1, 2025
  • Sutter RxDC overview
  • Survey Link
UnitedHealthcare,
Oxford
Carrier will report for groups using OptumRx as PBM.

Groups with other PBMs (including OptumRx Direct) should refer to the CAA UHC Approach to Pharmacy Benefits and Costs Reporting Guide
Carrier will report for groups using OptumRx as PBM.

ASO groups and groups with  other PBMs (including OptumRx Direct) should refer to the CAA UHC Approach to Pharmacy Benefits and Costs Reporting Guide

Survey required: due by March 31, 2025 

Survey is located in eServices. Groups can complete the employer worksheet prior to logging in.

  • UHC RxDC overview
  • Employer Worksheet for Gathering RFI Data
  • Employer Training for RFI Tool
Western Health AdvantageCarrier will report.n/aSurvey not required.

Small employers should review their Group Service Agreement Cover Sheet (renewal doc) to ensure contribution values are correct. This will be used for WHA reporting.

Large employers will be contacted by WHA to confirm contribution values.
-

 

Other Carriers:

  • CaliforniaChoice is providing requested data to all carriers and the carriers will report the RxDC information for the employers and plans.  There is no additional action needed by CaliforniaChoice groups.
  • The following are administrators and not responsible for reporting: Covered California and HealthPass. Employers should follow the enrolled carrier(s) for how reporting will be handled.
  • MediExcel Health Plan is exempt from reporting.

 

Carrier Articles Related to RxDC

RxDC

RxDC

02/05/2024

Kaiser Permanente®: 2024 Form Completion Required by Employers for Federal Reporting Under CAA - Act Now

To help ensure compliance with the CAA reporting requirements, employer groups must provide additional information. Take a look at this article to learn what is required.
01/02/2024

Sutter Health Plus 2023 Premium Reporting for Employers - Update

The Consolidated Appropriations Act of 2021 (Section 204) requires insurance companies and employer-based health plans to submit information to the federal government about premiums and cost-sharing. ...
05/19/2023

Update on Employer Responsibilities for the Upcoming RxDC Reporting Due June 1, 2023

Update on Employer Responsibilities for the Upcoming RxDC Reporting due June 1, 2023 May 2023 Many employers received an email from their carrier or TPA (for Self-Insured plans) requesting that ...
05/13/2023

Webinar Replay: RxDC Reporting - Do Employers Have To Submit Their Own D1 File?

RxDC Reporting - Do Employers Have to Submit Their Own D1 File? May 10, 2023 Many employers, especially those with fully-insured plans, were surprised when their carrier or TPA requested certain...
05/12/2023

UnitedHealthcare to Meet CAA Prescription Drug Data Collection (RxDC) Deadline

UnitedHealthcare is on target to submit Pharmacy Benefits and Costs Data (RxDC) by June 1, 2023
05/10/2023

Kaiser Permanente®: Releases Update on COVID-19 Coverage and CAA RxDC Reporting

In March, Kaiser contacted their current customers and brokers to request group specific information required for them to complete aggregated reports for pharmacy reporting under the Consolidated Appr...
04/12/2023

Covered California Small Business: Consolidated Appropriations Act, Section 204 Pharmacy Reporting

Covered California for Small Business (CCSB) serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CCSB is...
03/28/2023

Sharp Health Plan Prescription Drug Data (RxDC) Survey Requirement

Employers should submit their information by May 1, 2023. Understanding the RxDC Report Under Section 204 of the Consolidated Appropriations Act, insurance companies and employer-based health pl...
03/20/2023

Aetna Prescription Drug Data (RxDC) Survey Requirement

Data collection requirement for all Aetna small group plan sponsors Prescription drug data reporting submission due 4/1 Prescription Drug Data Collection (RxDC) reporting for the 2022 reference ...
03/15/2023

RxDC Information At Your Fingertips!

RxDC Information At Your Fingertips! Our broker partners and their clients have many questions on this latest topic and Amwins Connect website can assist you with answers. Brokers should be info...
03/14/2023

Western Health Advantage and Prescription Drug Data Collection Reporting (RxDC) Requirements

The RxDC is a data report required under section 204 of the CAA. This report requires health insurance issuers and group health plans to submit information about prescription drug and health care spen...
03/14/2023

Anthem Blue Cross RxDC Premium Reporting for Employers

Important premium information needed for the 2023 Prescription Drug Data Collection submission Anthem needs help collecting monthly average premium information required for Prescription Drug Data C...

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