Drug Cost Reporting for TPAs | It’s Not a Straightforward Process

For the TPAs in the Market Place that have had a chance to look at the Drug Cost Reporting requirements, you’ve probably also had the realization that pulling off this reporting is going to be a lot more difficult than you might have initially thought.

Its called Drug Cost Reporting so naturally the marketplace would think that the PBM (Pharmacy Benefit Manager) is going to be supplying most of this data. The thing to know is that the PBM is providing the majority of the needed data, but unfortunately what we are finding in the marketplace is that the PBMs are making logical decisions based upon their circumstances. What we mean is that, when one takes a look at the reporting requirements, they find that for the PBMs, in most cases it is in their best interest to just provide the data to the plan sponsor and allow the plan sponsor to report for themselves.

So, what does that mean? It means that the responsibility is ultimately falling back onto the TPAs. The current problem in the marketplace is that by in large people are thinking that the PBM has it taken care of on their behalf. The reality is that in most instances the PBM has but only a piece of the requirement taken care of.

As more responsibility is falling back onto the TPAs, we at DrugCostReporting.com are having conversations with them to help clarify how difficult it is to get their hands around all of the required administration.

As a holding company, we also own ACAReportingService.com. What we are seeing with the Drug Cost Reporting is very reminiscent of what we saw during the first year of ACA Reporting. Everyone in the industry was trying to figure out what this new compliance item was and how they would complete it. For this reason, we have launched consulting services as well as services provided all the way down to the plan sponsor. The goal of which is to help plan sponsors complete accurate and timely Drug Cost Reports.

Learn more about our drug cost reporting services.