May 12, 2023
UnitedHealthcare is on target to submit Pharmacy Benefits and Costs Data (RxDC) by June 1, 2023
UnitedHealthcare on target to submit Pharmacy Benefits and Costs Data (RxDC) by June 1, 2023
Any applicable data elements not provided to UnitedHealthcare will need to be submitted to CMS.
As previously communicated, pharmacy benefits and costs data (RxDC) for 2022 must be submitted to the Centers for Medicare and Medicaid Services (CMS) by June 1, 2023. UnitedHealthcare sent a survey requesting the required information to report data to CMS. Customers that did not complete this survey will need to submit P2 (Group Health Plan) and D1 (Premium and Life Years) data. After evaluating the updated instructions published by CMS, there will be no change to UnitedHealthcare’s current approach.
- Any applicable data elements not provided to UnitedHealthcare will need to be submitted to CMS by the health plan or another reporting entity
- Customers with carve out pharmacy need to submit the D3-D8 files directly or through another reporting entity
- UnitedHealthcare and Surest will work directly with CMS to resolve any discrepancies in data
Due to the volume of data, complexities navigating the survey database and the confidential nature of the data, UnitedHealthcare is unable to verify specific customer survey responses. However, UnitedHealthcare can confirm whether the customer completed the survey or not.
For customers that completed the survey, UnitedHealthcare will use the information provided to submit the RxDC files to the CMS by June 1, 2023. UnitedHealthcare can no longer accept any information from customers for this submission.
Certain P2 and D1 data that was part of the survey is not contained in the UnitedHealthcare systems. Customers that did not respond or did not complete the survey will need to submit that missing P2 and D1 data to CMS directly by June 1, 2023.
P2:
- Group Health Plan Name
- Form 5500 Plan Number (as applicable)
D1:
- Average monthly premium paid by members
- Average monthly premium paid by employer
CMS RxDC reporting instructions
