Government Provides Enforcement Relief for Rx Reporting

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The Departments of Labor, Health and Human Services, and Treasury recently announced some relief in regard to enforcing the Prescription Drug Data Collection (RxDC) reporting mandate.

Prescription drug reporting is a federal mandate created by the Consolidated Appropriations Act of 2021, which was signed into law in December 2020. It requires insurance companies and group health plans to report prescription drug data to the government. 

The federal Departments announced two types of relief for the 2020 and 2021 reference years. (The relief does not apply to the 2022 reference year reporting due June 1, 2023.)

First, "for the 2020 and 2021 data submissions that are due by December 27, 2022, the Departments will not take enforcement action with respect to any plan or issuer that uses a good faith, reasonable interpretation of the regulations and the Prescription Drug Data Collection (RxDC) Reporting Instructions in making its submission." 

This will help many reporting entities that are struggled to interpret the available guidance and apply it to their existing data and administrative processes. The Departments had previously announced in the text of the Instructions some limited enforcement relief in connection with reporting average monthly premiums for the 2020 and 2021 reference years, but this new announcement has a broader application.
Second, the Departments are giving plans and issuers more time to comply, by announcing a grace period that will run through January 31, 2023: "The Departments are also providing a submission grace period through January 31, 2023, and will not consider a plan or issuer to be out of compliance with these requirements provided that a good faith submission of 2020 and 2021 data is made on or before that date."

Why are they doing this? The Departments "recognize the significant operational challenges that plans and issuers may have encountered in complying with these reporting requirements."
They also recognize that "given the novelty and complexity of the requirements, there may be errors or other issues with the first round of data submissions, despite good faith efforts by plans and issuers."

After announcing the enforcement relief, the Departments then include in Part 56 a set of FAQs that answer some common questions and concerns about the data collection and submission process. 

The FAQs address such issues as:
  • Multiple submissions by the same reporting entity or by multiple reporting entities
  • Reporting on vaccines
  • The ability to submit certain limited data by email rather than through the HIOS system (which some users find challenging)
To check out the government FAQ, please click here.

To review Warner Pacific’s resource page of prescription drug reporting, click here.
Source: Monahan Law Office; The Departments of Labor, Health and Human Services, and Treasury