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The RxDC reporting provision of the Consolidated Appropriations Act (CAA) requires reports on drug utilization and spending trends to be submitted to U.S. Department of Health and Human Services. Reports are due annually by June 1.
View the Amwins Connect Health Cost Transparency Guide for Employers.
CMS Resources:
- Prescription Drug Data Collection Reporting page
- Prescription Drug Data Collection Reporting Instructions
- Prescription Drug Data Collection FAQs
How Carriers Will Handle Reporting
| CARRIER | REPORTING Fully Insured |
REPORTING Self/Level Funded |
EMPLOYER SURVEYS | RESOURCES |
|---|---|---|---|---|
| Aetna, Banner|Aetna |
Carrier will report. | Carrier will report. | Survey Required: Due April 12, 2024 Aetna will email a form directly to employers starting Friday, March 15. Employer will be asked to provide:
|
|
| Allstate Benefits | n/a | Details pending for 2024 | Details pending for 2024 | - |
| Anthem | Carrier will report. | Employer must report:
|
Survey Required: Due March 15, 2024 Anthem will email a survey directly to employers starting the week of Feb 12. ASO LG and National Accounts can opt-in to have Anthem file D1 Premium and Life Years report on their behalf. |
|
| Blue Cross Blue Shield of Arizona | Carrier will report. | Carrier will report. | No survey has been announced | - |
| Blue Shield of California | Carrier will report. | Varies; refer to the Reporting Grid. | Survey Required: Due April 5, 2024 Employers must report premium paid for healthcare coverage. Survey available in Employer Connection, but if no account then use the Prescription Drug & Healthcare Spending Survey (use group ID and web key #24yr23) . Late responses accepted until April 19. |
|
| CareFirst BCBS | Carrier will report. | Carrier will report. | Survey Required: Due May 10, 2024 Survey sent directly to employers on April 12. |
|
| Cigna | Carrier will report. | Carrier will report. | No survey has been announced | - |
| Cigna + Oscar | Carrier will report. | n/a | No survey has been announced | - |
| Cigna Administered by Oscar | Carrier will report. | n/a | No survey has been announced | - |
| ConnectiCare | Carrier will report. | n/a | Survey Required: Due May 3, 2024 Employers must report average monthly premium paid by employer vs employee. |
|
| EmblemHealth | Carrier will report. | Carrier will report. | Survey Required: Due May 3, 2024 Employers must report average monthly premium paid by employer vs employee. |
|
| Florida Blue | Carrier will report. | Carrier will report. | Survey Required: Due March 31, 2024 | |
| FHCP | Carrier will report. | n/a | Survey Required: Due March 31, 2024 | |
| Health Net | Carrier will report. | n/a | No survey required. | |
| Healthfirst | Carrier will report. | Carrier will report. | No survey has been announced | - |
| Humana | Carrier will report. | Carrier will report. | Survey Required: Due April 19, 2024 Fully Insured Survey Self-Funded Survey See the FAQ for what is needed to report based on funding type. |
|
| Kaiser Permanente | Carrier will report. | Carrier will report. | Survey Required: Due March 29, 2024 Kaiser will send the survey directly to employers, must provide:
Small groups associated with CCSB or CalChoice do not need to complete the form. These exchanges will provide the data to Kaiser who will report on their behalf. |
|
| Oscar | Carrier will report. | n/a | No survey has been announced | - |
| Sharp Health Plan | Carrier will report. | n/a | Survey Required: Due April 19, 2024 Employers must report:
|
|
| Sutter Health Plus | Carrier will report. | n/a | Survey Required: Due March 1, 2024 | |
| UnitedHealthcare, Oxford |
Carrier will report for groups using OptumRx as PBM. Groups with other PBMs (including OptumRx Direct) should refer to the CAA UHC Approach to Pharmacy Benefits and Costs Reporting Guide |
Carrier will report for groups using OptumRx as PBM. ASO groups and groups with other PBMs (including OptumRx Direct) should refer to the CAA UHC Approach to Pharmacy Benefits and Costs Reporting Guide |
Survey Required: Due April 10, 2024 Employers should use the Request for Information (RFI) worksheet to prepare responses prior to completing the RFI in the employer portal. |
|
| Western Health Advantage | Carrier will report. Small employers should review their Group Service Agreement Cover Sheet (renewal doc) to ensure contribution values are correct. This will be used for WHA reporting. Large employers will be contacted by WHA to confirm contribution values. |
n/a | No survey has been announced | - |
Other Carriers:
- The following are administrators and not responsible for reporting: CaliforniaChoice, Covered California, and HealthPass. Employers should follow the enrolled carrier(s) for how reporting will be handled.
- MediExcel Health Plan is exempt from reporting.
Carrier Articles Related to RxDC
RxDC
07/23/2024
Health Net | RxDC Report Filing Completed in May 2024
Health Net successfully filed the RxDC report for Oregon and California Small and Large groups on May 30, 2024.
06/03/2024
Blue Shield of California: Confirmation of RxDC Report Submission
Data submitted is for the preceding year, 2023. Blue Shield will also reach out to groups, informing them of the data submission.
05/07/2024
RxDC Reporting is Due June 1, 2024
RxDC Reporting is due to CMS by June 1, 2024 2023 Prescription Drug Data reporting is due June 1, 2024. As of the publication of this article, reporting of Rx Data is due to CMS in a little over...
04/11/2024
Blue Shield of CA | Prescription Drug Cost Reporting - Deadline to Submit D1 Data: April 19, 2024
Blue Shield of California is collecting D1 Premium Contribution data as part of the Consolidated Appropriations Act, Section 204 (2021)– Prescription Drug Cost Reporting regulation, on behalf of Blue ...
04/04/2024
RxDC Resources at Amwins Connect
RxDC Resources at Amwins Connect As we get closer to the deadline, you are probably receiving questions from your clients asking you what the carriers are doing or what are they not doing in order ...
03/18/2024
Blue Shield of CA | Improved Process for D1 Premium Reporting - RxDC Mandate
Groups and/or their brokers without Employer Connection access, including active groups, termed groups, and Covered California Small Business groups, can submit required information via the Prescripti...
03/18/2024
Sharp Health Plan Prescription Drug Data Collection Reporting (RxDC) Requirements
Employers should submit the requested information by April 19, 2024.
03/13/2024
Aetna Prescription Drug Data (RxDC) Collection Requirement
Aetna will reach out to groups via email, starting on Friday, March 15th. Groups must response with the requested information by April 12.
02/24/2024
Webinar Replay: RxDC Reporting Round 3
RxDC Reporting Round 3 January 31, 2024 Another round of Rx reporting is just around the corner. As we have started seeing communications from carriers and TPAs requesting data for the Rx report...
02/22/2024
UPDATE - CA | Kaiser Permanente® Form Completion Required By Employers Under CAA
Kaiser Permanente has submitted all required data for all groups (both fully insured and self-funded) for calendar years 2020, 2021, and 2022. For the 2023 calendar year, Kaiser Permanente plans to...
02/07/2024
UPDATED DATES: 2024 UnitedHealthcare/Oxford Approach to CAA Prescription Drug (RxDC) Reporting
UnitedHealthcare and Oxford fully insured and self-funded/level funded groups must complete the online tool for CAA RxDC reporting between February 16, 2024, and April 10, 2024.
02/05/2024
