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Compliance Corner

Under the Consolidated Appropriations Act (CAA) of 2021, reporting for 2023 data is due no later than June 1.

What is the Consolidated Appropriations Act, Section 204?

Title II (Transparency) of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116- 260) (CAA), establishes new protections for consumers to promote transparency in health care costs and, particularly, prescription drug costs.

Section 204 of the Transparency Title authorizes the collection of prescription drug and health care spending data from group health plans and health insurance issuers on an annual basis.

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 Department of Health and Human Services, Department of Labor, and Department of the Treasury will use the information submitted by reporting entities to inform their Section 204 Reporting in:

  • Identifying major drivers of increases in prescription drug and health care spending
  • Understanding how prescription drug rebates impact premiums and out-of-pocket costs
  • Promoting transparency in prescription drug pricing

Your CDB team has been diligently working to keep you compliant by ensuring CDB’s integrated Pharmacy Benefit Manager (PBM) partners are prepared to provide pharmacy data as required.

CDB will also provide necessary medical data and work directly with you to collect plan premium information, which will allow CDB to submit data to the CMS Enterprise Portal.

Additional information about the Consolidated Appropriations Act can be found here.

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