Horizon’s Approach to the CAA RxDC 2022 Reporting for Fully Insured Groups

See Horizon Brief Notes below regarding this topic

Horizon Brief Notes
Applies to: Fully Insured Plans

Horizon’s Approach to the CAA RxDC 2022 Reporting for Fully Insured Groups

Under Section 204 of the Consolidated Appropriations Act, 2021 (CAA), insurance companies and employer-based health plans are required to submit information about prescription drugs and health care spending to the Centers for Medicare & Medicaid Services (CMS). This data submission is called the RxDC (prescription drug data collection) report. This information must be submitted to CMS by June 1, 2023, for 2022 data, and every year after that, through a web portal set up by CMS. Please note that guidance for our self-insured groups was issued on April 5, 2023.

What information do insurance companies and employers submit to CMS?
The CAA requires insurance companies and employer-based health plans to submit information about:

  • Spending on prescription drugs and health care services
  • Prescription drugs that account for the most spending
  • Drugs that are prescribed most frequently
  • Prescription drug rebates from drug manufacturers
  • Premiums and cost sharing that patients pay

How will this information be used?
The data submitted by insurance companies and employer-based health plans will help to:

  • Identify major drivers of increases in prescription drug and health care spending
  • Understand how prescription drug rebates impact premiums and out-of-pocket costs
  • Promote transparency in prescription drug pricing

What do you need to know?
Horizon’s approach to CAA RxDC for fully insured groups with active prescription drug coverage in 2022 will be consistent with our approach for the reporting years of 2020 and 2021, submitted to CMS on December 27, 2022.

Horizon will:

  • Continue to submit a P2 Group Health Plan List, as well as a D1 Premium and Life Years data file and D2 Claims Spending by Category data file.
  • Continue to submit the D3-D8 Pharmacy data files for groups that use Prime Therapeutics as their Pharmacy Benefits Manager (PBM).
  • Submit corresponding Narrative Files.

Horizon WILL NOT:

  • Collect external carrier files to aggregate data.
  • Submit D3-D8 Pharmacy data files if Prime Therapeutics is not the designated PBM.

Why is Horizon not collecting information such as monthly premium?
Horizon has determined that there is sufficient internally captured data regarding the number of members in an insured plan, the life year’s calculation, premiums paid, rates, contributions, etc. to produce information for the D1 columns. 

Going forward, Horizon will review any additional clarification and guidance to ensure compliance with the RxDC requirements and will update our approach, if needed for future submissions. We will inform you of any change necessary to the current procedure.