RxDC Reporting

Under the Consolidated Appropriations Act (CAA), health insurers offering group or individual health coverage and self-funded group health plans are required to report data annually regarding prescription drugs and healthcare spending to the Departments of Health and Human Services, Labor, and Treasury (Tri-Agencies).

The next required submission date to report 2023 data is June 1, 2024. This information must be submitted through a web portal set up by the Centers for Medicare & Medicaid Services (CMS).

Please refer to the information below that applies to your 2023 health benefit plan arrangement / carrier for further information / reminder on next actions on your part.

Please note that ASG/UMR and Anthem are handling the reporting requirements for KTA employer groups. No action is required for KTA employers at this time.

Fully Insured Employer Groups:

Anthem (includes KCIT groups): Anthem will be submitting the files for all fully insured customers who had active coverage during the 2023 reference year. Anthem previously sent out an email containing a survey link to fully insured customers to gather needed information to complete their data for the upcoming filing. Employers MUST submit the requested data to Anthem by the due date of March 15, 2024 so that the filing can be complete. If any questions, or if you have not received your survey link via email, contact your Account Executive / Manager.

Humana: Humana will complete the RxDC reporting for their customers. Humana sent out a revised communication in late February amending the original survey link and the deadline to complete is now April 1, 2024. If the form is not completed by April 1, 2024, Humana will proceed to submit the report without the required plan sponsor data. The aggregated premium data submitted by Humana will not include the plan sponsor’s data. If the data is not submitted, the employer would be required to submit the information directly to CMS by 6⁠/⁠1/⁠2⁠0⁠2⁠4 to fulfill 2023 RxDC requirements. If you have not received the most recent Humana survey link via email, contact your Account Executive / Manager.

UnitedHealthcare (UHC): UHC will be submitting the files for all fully insured and level-funded customers who had active coverage during the 2023 reference year. UHC sent a communication to all fully insured and level-funded customers to gather needed information to complete their data for the upcoming filing. Customers are to submit the requested data to UHC via the employer portal by the due date of April 10, 2024, so that your filing can be complete.

Self-Funded Employer Groups:

The approach for self-funded employer groups varies. We have summarized below what we know currently regarding the carrier approaches for self-funded customers. Your Bim Group Account Executive / Account Manager can assist with required additional data to be supplied to your carrier / TPA.

Anthem:  Anthem ASO customers have the option to request that Anthem file the Data Sheet (D1) reports on their behalf provided that the request and required additional information is received by March 15, 2024. Anthem has sent an email to ASO customers with more information and what is needed for them to complete the filing. Your Bim Group Account Executive will also reach out to our Anthem ASO customers on how we can help support them in this endeavor. If you have questions, contact your Bim Account Executive.

Aspirant:  Aspirant will be submitting all files for their customers (assuming customers are utilizing their preferred pharmacy vendors) for the 2023 reference year. Aspirant has sent customers a survey linked below to procure needed information to complete their filing. Bim Group will assist in providing the needed data to customers to return to Aspirant.

Aspirant Survey Link

UMR:  UMR will be submitting the files for all customers who had active coverage during the 2023 reference year.   UMR has sent a survey (survey document linked below) to all impacted customers to gather needed information to complete their data for the upcoming filing. Bim Group will complete the UMR worksheet for customers to input needed data into the UMR survey link by the deadline of March 31, 2024. If you have questions, contact your Bim Account Executive.

UMR Survey Link

Humana (includes Level Funded):  Humana will complete the RxDC reporting for their customers. Humana sent out a revised communication in late February amending the original survey link and the deadline to complete is now April 1, 2024. If the form is not completed by April 1, 2024, Humana will proceed to submit the report without the required plan sponsor data. The aggregated premium data submitted by Humana will not include the plan sponsor’s data. If the data is not submitted, the employer would be required to submit the information directly to CMS by 6⁠/⁠1/⁠2⁠0⁠2⁠4 to fulfill 2023 RxDC requirements. If you have not received the most recent Humana survey link via email, contact your Account Executive / Manager.

We are providing this information as a reminder. You should have previously received information on your specific carrier / administrator’s approach to this reporting.

If you have questions regarding your obligations as an employer in this regard, please contact your Bim Account Executive / Manager.