Prescription Drug and Health Care Spending Delayed

On December 23, 2022, the Departments of the Treasury, Labor, and Health and Human Services provided health plans a small amount of relief in terms of complying with the new Prescription Drug and Health Care Spending reporting rules. These new reporting requirements, which were included in the Consolidated Appropriations Act of 2021, require plans to annual submit several data files related to prescription drug spending and other health care expenditures.

The initial disclosure covered the 2020 and 2021 plan years and was due on December 27, 2022. However, just before Christmas the Departments of Labor, Health and Human Services, and the Treasury (the, “Departments”) issued a temporary extension for the initial disclosure. The Departments have adopted a grace period for initial disclosures until January 31, 2023 and will not consider a plan or issuer non-compliant if a good faith submission is made on or before that date. Going forward, future submissions are due on June 1st following the end of the calendar year. For example, that means the 2022 calendar year data must be submitted by June 1, 2023.

The Departments also relaxed several restrictions related to the filings themselves. The data is split into eight separate spreadsheets to be uploaded to the Centers for Medicare and Medicaid enterprise portal. Previously, each reporting entity was required to submit one file on behalf of all of the Plans for which it was reporting. Now it can submit one file per plan if it desires. In addition, multiple reporting entities are able to submit the same data file if multiple entities have the required information. For example, a claims provider may submit the premium and membership numbers while the plan’s administrator submits the stop loss premiums. Rules regarding providers’ aggregation of data have also been relaxed.

Both changes are intended to reduce the burden these new reporting requirements impose on both plans and insurance carriers. Thankfully, the temporary grace period will give plans and issuers some extra time to review their submission and the relaxed restrictions should make compliance a little easier.