CAA Prescription Drug Reporting: What You Need to Know


What is prescription-drug reporting, and how does it affect you and your groups? Get the answers to these questions, and more, in this resource page.


What is Rx reporting?

Prescription-drug reporting is a federal mandate created by the Consolidated Appropriations Act of 2021, which was signed into law in December 2020. It requires insurance companies and group health plans to report prescription drug data to the government.


Why is the government doing this?

For years, prescription costs for drugs has been a hot topic. The federal government wants to use the data that will be reported to study the prescription drug industry; consider legislative or regulatory changes; and look at market concentration (i.e., essentially antitrust issues).


How does this affect agents and groups?

Insurance companies have sent a lot of questions and communications to groups about drug reporting. Some groups may not understand why this is happening. That’s where you come in: You can help guide your groups and facilitate the reporting process so they can meet their deadline.


Important things to note

Whether your group is fully insured or self-funded, they have to comply with this mandate.


Resources

Here are some important resources you can reference, including links to detailed break-downs:


Employer Group Responsibilities for Late Carrier Submissions

If the carrier submission deadline has passed and the required information has not been submitted, employer groups may be responsible for providing the survey data directly to CMS. In most cases, this will involve submitting the P2 and D1 files to CMS by June 1. To determine the average premium paid by the employee and employer, refer to the CMS Instruction Guide (pages 21-22), which outlines the calculation process. The average premium amount paid by a member includes both the employee and their dependents.


Important Notice: To ensure a smooth filing process, it is highly recommended that employers register on the website well in advance of the submission deadline. Keep in mind that registration verification may take several weeks. Disregarding the survey from the insurance carrier could result in the employer being held accountable for any delays or incomplete submissions.


For assistance with the submission process, visit the CMS Survey page. Additional information about RxDC reporting can be found on the CMS website. To stay updated on announcements and register for training webinars, visit the Registration for Technical Assistance Portal (REGTAP). If you can't find the answer to your question in REGTAP, contact the help desk at 1-855-267-1515 or email them. Include "RxDC" in the body of the email for faster service. Responses are typically provided within the same day, with a full resolution expected within 1-2 weeks.


Annual reporting schedule

Reports are due annually on June 1st.

Carrier Responses

In this section, you'll find information about how carriers are addressing the CAA Prescription Drug Reporting requirement, as well as the employer obligations required for each carrier.

                                                                                                           







Carrier*
Carrier Requirement
Carrier Official Response
Employer Survey
Who is Reporting
Resources
Aetna   

Employers must provide the following information to Aetna, which will be used to submit on behalf of the plan sponsor:

•    Average monthly premium paid by members

•    Average monthly premium paid by employer

•    Funding arrangement

•    Issuer name/legal entity

 

Aetna submitted all required reports for the 2022 reference year on behalf of all Small Group plan sponsors. If the plan sponsor did not complete the survey with the required premium information, then the report was released incomplete and did not include the required plan sponsor premium information. 

The plan sponsor will be responsible for ensuring the average monthly premium paid by members and by the employer are submitted directly to CMS through their HIOS portal by 6/1/23. Aetna is not responsible for any liability associated with an incomplete report due to missing information.



RxDC Plan Sponsor Data Collection Form

•    If a plan sponsor initially submits incorrect information, they can resubmit their form(s) with the updated information. Aetna will retrieve the most current form(s) submission on 4/1/2023. 

Deadline for submission is 4/1/2023

•    A plan sponsor will need to submit a form for each product based on Aetna’s legal entity.
     -For California HMO plans, the plan sponsor will submit a form for all their Aetna HMO plans under Aetna Health of California as their issuer/legal entity.

     -For non-HMO plans, the plan sponsor will submit a form for all California OAMC/PPO plans under Aetna Life Insurance Company as their issuer/legal entity.

• Reminder - If a plan sponsor does not complete the form, Aetna will submit the report without the required plan sponsor data and the report will be considered incomplete. The plan sponsor will need to submit the information to CMS directly by 6/1/23. 

Fully Insured: Carrier

Self-Funded: Carrier
Pharmacy Benefit and Drug Reporting
Anthem (CA)
Starting in 2023, Anthem is requiring employers to provide information on the average monthly premium paid by the member and the employer in the Premium and Life Year (D1) reporting.Anthem is filing an aggregated response for all California Small Group (Full Insured) based on all the information we received. If a broker did not respond to the survey, their specific info would not be included in the aggregate filing. However, they’ll still be part of the filing. ( e.g. if Anthem has 10,000 groups but only get 8,500 survey responses Anthem will report for all 10,000 groups based on what they received from the 8,500.)

Fully Insured:

RXDC Average Monthly Percentage and Premium Reporting 
Deadline for submission is 3/24/2023

 

Self-funded groups that want Anthem to submit their 2022 D1 reports need to complete this form with all required information no later than3/24/2023.
Fully Insured: Carrier

Self-Funded: Anthem will submit if the employer completes the form by the required deadline.

Broker Announcement


Prescription Drug Data Collection Reporting Provision


Self-Funded Group Announcement 

Anthem Blue Cross Blue Shield (CO)

Starting in 2023, Anthem is requiring employers to provide information on the average monthly premium paid by the member and the employer in the Premium and Life Year (D1) reporting.

N/ARXDC Average Monthly Percentage and Premium Reporting
Deadline for submission is 3/24/2023
Fully Insured: Carrier

Self-Funded: Pending carrier response 
Broker Announcement
Anthem Blue Cross Blue Shield (TX)
Carrier Requirement: Please submit your average monthly premiums paid by members and the average monthly premiums paid by employer for the 2022 reference year.N/A

Your Next Steps:

1. Log in to Blue Access for Employers    or Register Here if you are new to BAE.

2. Click Prescription Drug Data Collection under Regulatory Data Collection on the BAE homepage to complete the form.

3. Enter your 2022 average monthly premiums paid by employer and members by April 13.

4. Click Submit. 

Blue Cross and Blue Shield of Texas (BCBSTX) must submit reporting to the Centers for Medicare and Medicaid Services (CMS) for our fully insured customers who have prescription drug coverage. To complete this reporting requirement for those groups, we will need the account’s benefits administrator to provide us with some information. Blue Access for Employers
APEX
RCI will be collecting data annually from each employer to complete the RxDC reporting. You may have submitted data in the prior year; however because information may change, we must collect data each year.N/APlease complete this survey by April 20. 

Before starting the survey, you should gather some data that will be required for the survey such as the Member and Employer Average Premium and your Health Plan name as it appears in the RCI Portal.
RCI will be submitting the files for all employers who had active coverage during the 2022 reference year.  RCI is working with CitizensRx, the PBM on all Apex MEC plans, to submit the D3-D8 files.Broker Announcement
Blue Shield of California  
In preparation for the reports due June 1, 2023, Blue Shield is collecting and reporting D1 Premium and Life Year data on behalf of our groups and group plan sponsors. 

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 our employer groups. 

 

To ensure group data is included in Blue Shield’s aggregate filing, groups will need to fill out the Blue Shield D1 intake form.

  • Active groups will need to fill out the intake form available on Employer Connection upon logging in.
  • Terminated groups will need to fill out this intake form, using their Blue Shield group ID and following web key: #24yr23.

The deadline to provide information is Friday, April 5, 2024 at 6:00PM (PST). 

 

Groups that miss this deadline will not be included in Blue Shield’s filing and may be subject to non-compliance if they do not report the required data directly to the CMS on their own. 

 

As a reminder, Blue Shield will submit D2 for all groups and D3-D8 for groups with prescription drug benefits under a Blue Shield health benefit plan. If a group does not have prescription drug benefits with Blue Shield, they should coordinate submission of D3-D8 with their pharmacy/prescription drug benefits carrier. Please see sections 6 and 7 of the CMS Instructions Manual for information on each of the reporting elements. 

 

Please note that data submitted is for the 2023 calendar year. For group plan sponsors whose benefit structure includes multiple groups (subgroups), the intake form must only be completed for the group, and not subgroup, under the main group ID. 

 

Here are a few reminders to prepare for submission:

  • Brokers or other delegates of the group may fill out the intake form on behalf of the group. If you do not have access to the intake form for active groups via Employer Connection, please reach out to your group for delegate access.
  • Only one individual may submit responses for a single group ID. Multiple individuals will not be able to submit information for a single group. Please coordinate submission with your group and any other delegates.
  • A single broker or delegate may, however, submit a response for multiple groups.
  • You may preview the intake form questions before submitting responses. Please submit the form only when all requested information is available.
  • You may preview the intake form questions before submitting responses. Please submit the form only when all requested information is available.
  • Once responses are submitted, only the submitter will have access to edit responses.
  • Multiple submissions can be made until the deadline of April 5, 2024.
  • Submitters will receive an email confirmation displaying their submitted responses and a link to edit responses. If you are completing the intake form on behalf of a group, please forward the confirmation email to the group.

We are requesting the following data from groups:

  • Basic group information such as submitter email
  • Healthcare premium percentage paid by employer for Small Business Groups and Large Groups that have pharmacy/prescription drug benefits with Blue Shield or,
  • Total healthcare premium paid by employer and employee, for Large Groups that have pharmacy/prescription drug benefits with another carrier besides Blue Shield
  • Total Premium Equivalent Amount (for self-funded ASO only, when applicable) - Total cost of providing and maintaining coverage, including claims costs, administrative costs, self-funded ASO and other TPA fees, and stop-loss premiums

Blue Shield is committed to supporting our groups in complying with health coverage related regulatory requirements.* Please support your groups by reminding them to submit necessary information before the deadline and helping submit information in the intake form, as needed. 

 

Please view the D1 Intake FAQs for more information. If you have any additional questions, please contact your Blue Shield representative.

Groups need to fill out this intake formbefore March 31, 2023
 
New reporting instruction was recently released by the Centers for Medicare and Medicaid Services (CMS). Under this new guidance, Blue Shield will submit D1 for all fully-insured groups (both groups with and without Blue Shield pharmacy benefits), even those who did not complete the D1 Intake Form.

Fully Insured: Carrier

 

Self-Funded:click here for details
Broker Announcement
CAA FAQs
CaliforniaChoice (CA)
Employers should refer to Carrier for specific reporting requirements.N/AEmployers should refer to Carrier for specific reporting requirements.Employers should refer to Carrier for specific reporting requirements.Employers should refer to Carrier for specific reporting requirements.
Cigna 
For the June 1, 2023 submission, which will represent the reporting year 2022, Cigna’s standard approach is to submit on our clients’ behalf.N/A

To submit the June 1, 2023 report: 

Send an email to the address found in the communication sent from Cigna with the client name, account number, and average employee, versus employer percent of premium across the client’s medical, pharmacy, and behavioral coverage corresponding to their population with Cigna coverage by February 24, 2023. Include both Cigna and non-Cigna coverage.


Fully Insured: Carrier

 

Self-Funded: Carrier 

Broker Announcement
Cigna + Oscar  
Refer to resource announcement.

For the June 1, 2023 submission, which will represent the reporting year 2022, Cigna’s standard approach is to submit on our clients’ behalf.

 

Employer Survey: N/A (we are filing this for our clients and don't need extra data)
Refer to resource announcement.

Fully Insured: Carrier

 

Self-Funded: N/A
Consolidated Appropriations Act (CAA) Section 204 Medial and Pharmacy Reporting

Prescription Drug and Health Care Spending Report
Covered California for Small Business (CA)
Employers should refer to Carrier for specific reporting requirements. N/AEmployers should refer to Carrier for specific reporting requirements. 

Fully Insured: Carrier

 

Self-Funded: N/A
Employers should refer to Carrier for specific reporting requirements.
Gravie (CO Level Funded)
Pending carrier responseN/APending carrier responsePending carrier responseBroker Announcement
Health Net  
Health Net will file the RxDC on behalf of its Commercial groups. The group does not need to report any data to Health Net. Pending carrier responseN/A

Fully Insured: Carrier

Self-Funded: N/A 
N/A
Humana 
Humana is currently working to develop a process for gathering average monthly premium paid by employers versus members for the 2022 reference year report and beyond. Fully-insured and self-funded groups will be contacted once a process is developed.Pending carrier response

 Pending carrier response

Fully Insured: Carrier

Self-Funded: Carrier - see Broker Announcement for details.
Broker Announcement
Kaiser Permanente 
 Kaiser Permanente will be reaching out to fully insured employer groups to obtain the following:
  • Average Monthly Premium Paid by Member
  • Average Monthly Premium Paid by Employer
  • Form 5500 Plan Number (If Applicable)
At this time, Kaiser Permanente is awaiting the final guidance for 2022 reporting. 
Pending carrier responseSurvey Link for Employers
Deadline for submission is 4/3/2023.
Fully Insured: Carrier

Self-Funded: Carrier
Broker Announcement
Memorial Hermann Health Plan 
Memorial Hermann Health Plan will be filing all required information on behalf of your employer groups. Please complete the form fillable spreadsheet no later than 4/15/2023.
 
N/AForm fillable spreadsheet
Deadline for submission is 4/15/2023.
Fully Insured: Carrier

Self-Funded: Carrier
Broker Announcement
Sharp Health Plan (CA)

Per the Centers for Medicare & Medicaid Services’ instructions, Sharp Health Plan is requesting the following information from our employers to complete the D1 Template for 2022 data:


• Average monthly premium paid by members


•Average monthly premium paid by employer

Employer FAQ


The deadline for Employers to submit their information to Sharp was 5/1 and they are not extending this deadline.  For Employers who chose not to complete the form, they will need to file directly with CMS by 6/1.  Sharp has posted on their website additional resources from CMS (e.g. the reporting instruction manual) that Employers can use as guidance.

New RxDC employer reporting intake form

 

The purpose of this intake form is to gather the required information to enable Sharp Health Plan to complete the D1 Template on your behalf. Please provide the information requested below for the 2022 calendar year and submit it by May 1, 2023.

Fully Insured: 

Sharp Health Plan will be submitting all elements of the 2022 RxDC filing by the June 1, 2023 due date; however, if an employer group does not provide the requested information by May 1, 2023, we will not be able to include that employer groups’ information in our filing. In that case, the employer group will be responsible for submitting all required data directly to the Centers for Medicare & Medicaid Services by June 1, 2023.


Self-Funded: N/A

Employer landing page

 

Broker landing page

Broker Alert: Employers’ monthly premium data needed
Sutter Health Plus (CA)
Employer groups must submit information to Sutter Health Plus regarding the average monthly premiums paid on behalf of enrollees and the amount paid by enrollees each year.N/A

Survey Link for Employers || Printable PDF

Deadline for submission is 3/1/2023
Fully Insured: Carrier

Self-Funded: N/A
Broker Announcement
UnitedHealthcare 
UHC Pharmacy Benefits and Cost Survey FAQUnitedHealthcare (UHC) submitted 2022 RxDC data, adhering to CAA, covering UnitedHealthcare, UMR, Surest, Oxford Level Funded/All Savers customers. Data not in UHC's system or RxDC survey was expected to be CMS-submitted by the customer/vendor. 

Survey Link for Employers

Deadline for submission was 3/10/2023.

Fully Insured: Carrier

Self-Funded: Data not in UnitedHealthcare's system or RxDC survey was customer/vendor-submitted. Self-funded customers handled their submissions. For more info, click here.
N/A

*Disclaimer: Please refer to carrier-specific guidelines for complete details and additional information.


Questions?

Call your Warner Pacific Sales Executive at (800) 801-2300.

Need Help? If you need assistance with RxDC reporting, please go to our compliance tools.


N/A



CARRIER*
EMPLOYER SURVEY
WHO IS REPORTING

Fully Insured

WHO IS REPORTING

Self/Level Funded/ASO

RESOURCES
Aetna   
Pending 2024Carrier will report

Pharmacy Benefit and Drug Reporting

Anthem (CA)


Anthem Blue Cross Blue Shield (CO)
Fully Insured Form 
Please submit by March 15, 2024


The week of February 12 – Fully Insured clients


Carrier will email Fully Insured National Account, Large Group, and Small Group commercial clients, as well as clients with Minimum Premium, MEWA, and Anthem Balanced Funding plans. The email will include a link to an online form for these clients to provide the information we need to complete the filings on their behalf.  


Anthem is filing an aggregated response for all California Small Group (Full Insured) based on all the information they received. If a broker did not respond to the survey, their specific info would not be included in the aggregate filing. 



The week of February 12 – ASO client D1 opt-in


Carrier will email ASO Large Group and National Account clients, and provide a link for them to request that we file their 2023 D1 Premium and Life Years report. For those who opt in, we will submit the aggregated data by market segment on their behalf for the benefits we administer and maintain.    


Groups that want Anthem to submit their 2022 D1 reports need to complete the survey with all required information no later than 3/15/2024



RxDC Reporting Announcement


(Opens in a new window)


Anthem Blue Cross Blue Shield (TX)
Pending 2024Carrier will report


Blue Access for Employers


RxDC Reporting Announcement

AvMED
Pending 2024Carrier will report




Blue Shield of California  

Upon logging in, active groups will need to fill out the intake form available via a banner on Employer Connection.
 
Terminated groups will need to fill out 
this intake form, using their Blue Shield group ID and following web key: #24yr23.

 

Survey deadline is April 5, 2024

Carrier will report

Please view the D1 Intake FAQs
Refer to submission grid

Broker Announcement

CAA FAQs

 
Cigna 
Pending 2024Carrier will report



Cigna + Oscar  
Pending 2024Carrier will report
N/A

 
    
Gravie (CO Level Funded)
Pending 2024




Health Net  
No survey requiredCarrier will report
N/A

Broker Announcement

Humana 
Online survey sent to health plan sponsors
Carrier will report


(CAA) Prescription Drug Data Collection (RxDC)

Kaiser Permanente 

Pending 2024

Carrier will reportCarrier will report
Broker Announcement
 
Sharp Health Plan (CA)
Pending 2024Carrier will report
N/A

Employer landing page

 

Broker landing page

Sutter Health Plus (CA)
Pending 2024Carrier will reportN/A


UnitedHealthcare 


To access the RFI tool, the employer must go to the employer portal beginning February 14, 2024.


The RFI must be completed by the April 10, 2024, deadline. 



UnitedHealthcare will be submitting the P2 (Group Health Plan), D1 (Premium and Life Years), and D2 (Spending by Category) files for all employers who had active coverage during the reference year (2023).

 

UnitedHealthcare will also submit the D3-D8 data files for customers with OptumRx as an integrated PBM. UnitedHealthcare has access to all data required to complete the submission of D3-D8.



UnitedHealthcare submits all data and appropriate narratives for plans administered by UnitedHealthcare and OptumRx carve-in (integrated). There is no fee for clients who follow the standard approach. 

• UnitedHealthcare will submit the P2 (Group Health Plan list), D1 (Premium and Life Years), and D2 (Spending by Category) files for all clients who had coverage in the 2023 reference year. 

• For clients with OptumRx integrated PBM, UnitedHealthcare will also submit the D3-D8 files.


Broker Announcement

CAA FAQs


Western Health Advantage

Pending 2024
Carrier will report
N/A