HHS Releases Revised Instructions for Upcoming Prescription Drug and Health Care Spending Reports

HHS has released revised instructions for group health plans and insurers to report prescription drug and health care spending data, as required by the Consolidated Appropriations Act, 2021 (see our Checkpoint article). As background, regulations describing the content and timing requirements for data submissions have established that plans and insurers must submit annual spending, premium, and enrollment information based on the “reference year” (i.e., the calendar year immediately preceding the calendar year in which the data submission is due) (see our Checkpoint article). Reporting instructions were released for the 2020 and 2021 reference years (see our Checkpoint article).

Reporting instructions for the 2022 reference year are now available. The instructions provide step-by-step guidance for submitting data through the RxDC module in the Health Insurance Oversight System (HIOS). The instructions also address who must report and when, and include detailed explanations of spending categories and data aggregation rules. Among other things, the 2022 reporting instructions have been revised to allow multiple vendors to submit data files on behalf of the same plan or insurer. They also address suspended data aggregation restrictions and provide additional guidance on reporting prescription drug rebates.

EBIA Comment: The deadline for the 2022 reference year report is June 1, 2023 (see our Checkpoint article). The instructions confirm that account-based plans (such as HRAs) and plans that provide only excepted benefits (e.g., limited-scope dental and vision plans, hospital or other fixed indemnity insurance, and disease-specific insurance) are not required to submit a report. For more information, see EBIA’s Health Care Reform manual at Section XXXVI.L (“Prescription Drug and Health Care Spending Reporting”). See also EBIA’s Self-Insured Health Plans manual at Section XXIX.D.4 (“Prescription Drug and Health Care Spending”) and EBIA’s ERISA manual at Section XXI.C (“Caution Regarding Additional Obligations”).

Contributing Editors: EBIA Staff.