Background: The Consolidated Appropriations Act of 2021 (H.R. 133) requires employer health plans to report a substantial amount of pharmacy and medical claims data by December 27, 2021, and again every year beginning June 1, 2022. Employers will have to modify their PBM and other third-party administrator contracts to obtain most of the required data. DOL, HHS, and the Treasury Department have requested information on how to implement the reporting requirements.
Our comments note that employer plans do not have most of the pharmacy and medical data they are required to report. In addition, there may be cases where medical providers and/or entities in the pharmacy supply chain simply refuse to provide the data for proprietary reasons, since there is no penalty for not providing the data. The liability for failing to report falls on employer plan sponsors.
This raises several questions: What happens to plan sponsors if they cannot get the information from their vendor(s)? What happens if a vendor does not provide accurate data?
The Association requests that the departments allow employer plans to make a good faith effort to report whatever data they can obtain for the December 27, 2021 and June 1, 2022 reporting dates.The comments also recommended that the departments use all the statutory authority they have to require medical providers and entities in the pharmacy supply chain to provide all statutorily required data and make it available to any third parties employer plans contract with.
Outlook: HR Policy and the Institute will be meeting with the three departments to discuss our comments and will submit additional comments on the proposed rule anticipated this fall.
