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March 1, 2024

We’re preparing to support groups’ 2023 Prescription Drug Data Collection (RxDC) reporting to the Centers for Medicare & Medicaid Services (CMS). The reporting is mandated by the Consolidated Appropriations Act, 2021 (CAA) and requires insurers and group health plans to submit spending data each year to CMS on prescription drugs, health plan premium, administrative fees and stop-loss where applicable.

We submitted 2021 and 2022 RxDC reporting for the benefits we administered on behalf of all fully insured groups and for self-funded groups that authorized us to do so. We had to collect certain data from self-funded groups to complete their reporting, and some self-funded groups opted to submit their reporting through another entity.

For 2023 we’re again required to collect from groups data we don’t hold in our systems. To enable groups to provide us the needed data, we’re implementing a new self-service RxDC data collection form on Employer Center. The form will be live for groups’ use beginning March 15, 2024.

Here’s what data we’ll need to collect from groups on the form:

• Fully insured groups must provide the dollar amount for Regence medical premium they collected from all enrolled employees in 2023.
• Self-funded groups must provide us the same data they provided for 2021-22: premium equivalents and a D1 (premium and life years) file for the benefits we administered in 2023.

As a reminder, we’ll submit groups’ RxDC data only for benefits we administer. We won’t submit data for benefits we don’t administer. Self-funded groups should consult their carve-out providers on reporting of data for any benefits administered by entities other than Regence.

We won’t include in our 2023 RxDC submission to CMS data for groups that don’t submit their required data to us by April 30, and groups that request that we send them their data that we hold. Those groups will need to submit their reporting independently or through another entity. (Reporting instructions can be found here.)

Employer Center is our online platform that group administrators use to conveniently manage their benefits. If your groups don’t currently have access to Employer Center, please urge them to visit employercenter.regence.com and click Request access to get set up before the data submission deadline.

Note that appointed producers can fill out RxDC data collection forms on behalf of their groups. However, Regence account representatives can’t fill out data collection forms on behalf of any groups or producers.

We published an initial article notifying employers about our new process and requirements for collecting their 2023 RxDC reporting data in the Jan. 30, 2024, edition of Employer News. We’ll remind employers about the process and their requirements in the March 26 and April 23 editions of Employer News. After reporting is completed on or before June 1, we’ll share reporting confirmation numbers provided by CMS.

Questions? Please contact your account representative.