Federal prescription cost reporting system takes shape



What would you like to know

  • Commercial insurers and plans would send general information about each plan or policy they offer.
  • A payer would list the total claim for each of the 50 most commonly dispensed brand-name prescription drugs.
  • The first federal reports on drug spending by commercial payers could be released in mid-2023.

Four federal agencies are starting to put in place what could be a large and complicated prescription plan cost reporting program.

On Monday, the agencies launched a request for ideas on how to implement the drug cost transparency provision of the Consolidated Appropriations Act 2021 (CAA 2021), which requires every health insurance issuer or self-funded employer health plan to send the government an annual report. providing:

  • General information on the size and location of each plan or coverage offered by the payer.
  • A list of the 50 most frequently dispensed brand-name prescription drugs by the payer.
  • The total number of claims paid for each of these 50 drugs.
  • The 50 most expensive prescription drugs by total annual expenditure.
  • The amount the payer expects to spend each year on the 50 most expensive drugs.
  • The 50 drugs with the sharp increase in plan spending, compared to the previous year’s spending.

The organizations concerned are the Employee Benefits Security Administration (EBSA) of the US Department of Labor; the United States Office of Personnel Management (OPM); the US Department of Health and Human Services (HHS); and the Internal Revenue Service.

The new reports

Every two years, agencies are expected to use the annual reports to prepare analyzes of the US prescription drug market, and which drugs cause the most cost problems.

The Centers for Medicare and Medicaid Service, a branch of the HHS, already publish detailed information on Medicare prescription spending.

The rules outlined in the information request call for commercial payers to send the government the first batch of drug cost reports by December 27, 2021, and then file subsequent series of reports annually, by June 1. .

The first biennial federal drug market analyzes would start to come out in mid-2023.

Thinner stitches

Here are three more things to know about requesting pharmacy fee information.



Comments are closed.