Nov 09, 2022
The RxDC is a data report required under section 204 of the CAA. This report requires health insurance issuers, such as Humana, and group health plans to submit information about prescription drug and health care spending to the Department of Health & Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (“Tri-Agencies”).
The deadline to submit RxDC data for 2020 and 2021 is December 27, 2022. RxDC data for each subsequent year is required to be filed annually by June 1.
Fully-Insured Customers
Humana plans to submit all (Files P2, D1-D8) reports for all their fully-insured customers. For customers with health plans that ended prior to the end of the reporting year, Humana will report data up to the date the plan termed.
Self-Funded Customers
When Humana administers both medical and pharmacy benefits for self-funded customers, Humana will complete and submit all applicable reporting templates (Files P2, D1-D8). For customers with health plans that terminate prior to the end of the reporting year, Humana will report data up to the date the plan termed.
When Humana only administers medical benefits for self-funded customers (the arrangement carves out pharmacy benefits), Humana will only complete reporting templates P2 – Group Health Plan List, D1 – Premium and Life Years, and D2 – Spending by Category as applicable to the customer’s medical benefits data. Self-funded customers with a pharmacy carve out arrangement will need to ensure pharmacy reporting templates D3-D8 templates are completed and submitted to the Tri-Agencies for their pharmacy benefits.
When Humana only administers pharmacy benefits for self-funded customers (the arrangement carves out medical benefits), Humana will only complete reporting template P2 – Group Health Plan List and templates D3-D8 as applicable to the customer's pharmacy benefits data.
Self-funded customers with a medical carve out arrangement will need to ensure medical reporting templates D1 – Premium and Life Years, and D2 – Spending by Category are completed and submitted to the Tri-Agencies for their medical benefit.
Read Humana's Prescription Drug Data Guide.
