RxDC Reporting for HealthCare Brokers

For those brokers who have fully explored the new Drug Cost Reporting Requirements, you are likely aware that this effort will require coordination between your Plan Sponsor Clients, their TPA(s), and their PBM(s). Why are so many parties involved?  PBMs lack the data necessary to complete the plan level files as well as data files 1 & 2. Further, TPAs also lack data necessary to complete their end of the reporting.

This creates a precarious situation for brokers as the marketplace is under the impression that ‘PBMs have it covered‘ since after all this is supposed to be Drug Cost reporting.  Unfortunately, too often this leads to blaming the broker as everyone begins to fully understand the reporting.  

It is important for brokers to understand that you cannot perform this reporting on your end because you do not have the necessary data.  We recommend that your role be one of facilitating all parties to ensure the reporting is completed.  As you question your TPA(s) and PBM(s), to the extent that the reporting falls back onto the plan sponsor, we’ve got you covered.   

It was for this reason we provide drug cost reporting services to:

• Assist in the collection of all data necessary for RxDC reporting compliance
• Aggregate all claims data from the plan sponsor as well as files provided by TPAs and PBMs
• Collaborate with plan sponsors to ensure final reporting is accurate and timely
• Partner directly with plan sponsors to service questions regarding the required reporting
• Merge and coordinate all claims data
• Prepare and submit RxDC reports on behalf of plan sponsor to the departments
• Service plan sponsors on an ongoing basis as questions or claims audits arise
• Offer healthcare claims consulting services directly to TPAs and PBMs
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