The Consolidated Appropriations Act requires employer health plans to annually report:
- The 50 most frequently prescribed drugs along with the total number of prescriptions filled for each;
- The 50 drugs the plan spent the most on and the amount spent for each;
- The 50 drugs that increased the most in cost relative to the prior plan year and the change in expenditure for each drug relative to the prior plan year;
- Total plan spending broken down by the type of health care services (e.g., hospital costs, health care provider and clinical service costs for primary care and specialty care, and prescription drugs);
- Average monthly premium paid by employer and employee; and
- Any impact on premiums or out-of-pocket costs relating to rebates, fees, etc. paid by drug manufacturers to the plan or the plan’s service providers.
The Association will be reaching out to members to get feedback to inform our comments for submission. Please email Mark Wilson at [email protected] if you are interested in discussing your concerns with this reporting requirement.
Data will be used to create an annual DOL report on prescription drug reimbursements under group health plans, prescription drug pricing trends, and the role of prescription drug costs in contributing to premium increases or decreases under such plans.
Outlook: The statute is very prescriptive regarding what needs to be reported, giving little leeway to DOL’s reg-writers. The RFI will be followed by a proposed rule and then a final rule. However, given the difficulty employers will have in obtaining this information from their third-party administrators and PBM’s, the Association intends to ask for at least a one-year delay in the reporting requirement's effective date.
