If you submit or apply for coverage for group health plans in Texas every year, you must also know how to submit your Prescription Drug Data Collection (RxDC). All health insurance issuers must submit this document, regardless if they carry either individual or group coverage. For smaller companies without an HR department, you need to be aware of the following criteria:
Under Section 204 (of Title II, Division BB) of the Consolidated Appropriations Act, 2021 (CAA), insurance companies and employer-based health plans in Texas. must submit information about prescription drugs and health care spending. This data submission is called the RxDC report. The Rx stands for prescription drug and the DC stands for data collection.
The Centers for Medicare and Medicaid Services (CMS) is collecting the RxDC report on behalf of the Departments of Health and Human Services, the Department of Labor, the Department of Treasury, and the Office of Personnel Management.
Section 204 requires all health insurance issuers offering individual health or group health plans coverage, including all fully insured and self-funded group health plans, to submit reports to The Centers for Medicare & Medicaid (CMS) on behalf of the Tri-Agencies and OPM.
The premium must be reported by average monthly premium paid by employers and average monthly premium paid by enrollees.
Average monthly premium paid by employers = Total Annual Premium paid by Employer / 12
*In the event you changed insurance carriers in 2022, please see next step:
Average monthly premium paid by employers = Total Annual Premium paid by Employer / # of months with the carrier you are reporting to
Most insurance carriers will submit the report for clients, however, carriers are requiring that Employers provide information in order to submit the report to CMS. Please refer to the list below by carrier on how and by when to submit the information requested.
Submitting to Top Group Health Plan Carriers in Texas – Rio Grande Valley, Austin, and Houston
Where to submit information: BCBSTX will need to obtain the Average Monthly Premium data from the client. Groups were notified via email and asked to submit the information through Blue Access for EmployersSM (BAESM) in the “Regulatory Data Collection” Section as seen below:
Then click on drop down to enter the requested information:
Deadline: The data and attestation in BAE must be completed by April 13, 2023 to be included in our overall RxDC submission.
Additional Blue Cross Information: https://www.bcbstxcommunications.com/newsletters/bv/2023/0303/stories/NLT_EMPL_BV_TX_030323_DRUG_DATA_COLLECTION.html
United Healthcare previously communicated with Employers regarding how to submit information and provided a deadline of March 3, 2023. Since the final rule regarding reporting has not been released, we have reached out to UHC to inquire if they will reopen the survey so clients may have additional time to submit their data. More information TBD.
Where to submit Information: https://www.aetna.com/employers-organizations/forms/rxdc-self-report.html
Deadline to submit Information: April 1, 2023
Humana is creating a report to allow groups to submit data related to the 2022 RxDC reporting requirements. They will release more information when this process is complete, so that group premium responsibilities or other necessary information can be provided at that time. We will follow up with more information as it becomes available.
Inquiry sent to Cigna. More information to follow.
Memorial Hermann is currently working on a strategy and will send out more information soon. More information TBD.
Lucent’s Compliance Department is currently working on communication regarding RxDc reporting for the 2022 plan year and will send out more information soon. More information TBD.
Unknown – Inquiry sent to ABA. More information to follow.