The Consolidated Appropriations Act of 2021 (CAA) requires health plan sponsors to submit detailed information on prescription drug expenses and coverage reports to the Centers for Medicare and Medicaid Services (CMS).
Fully-Insured Groups
For fully-insured groups, carriers are largely taking on the responsibility of reporting, but employers must still ensure that the carrier is filing on their behalf. It is important for plan sponsors to keep any written communication from the carrier that states how they are complying with the reporting requirement on behalf of fully-insured plans.
Self-Insured Groups / Level-Funded Plans
Self-insured groups, including level-funded plans, have more responsibility in ensuring the reporting is completed. We recommend that self-insured (and level-funded) plan sponsors contact their carrier, TPA and/or PBMs to ensure how these vendors can assist with the reporting requirement.
Self-insured plans may enter into a written agreement with their vendors to fulfill the reporting function on behalf of the plan; however, the plan sponsor remains liable for any failures.
RxDC Carrier Guidelines
For your reference, Ascela has prepared a document for RxDC Reporting carrier guidelines.
Please click the button below to access.