Since this reporting is new to the marketplace starting in 2022, you might be confused by the terms used such as:
- Drug Cost Reporting
- Section 204 Data
- Prescription Drug and Health Care Spending Reporting
The good news is these are all essentially the same thing. Under Section 204 of the Consolidated Appropriations Act of 2021, Plans and Issuers (carriers) must submit detailed prescription drug and healthcare spending metrics to the ‘Departments’ on an annual basis.
Based upon this description you might be thinking this is straightforward and your carrier (if you are fully insured) or your PBM (if you are self-insured) can handle this. Unfortunately, as often is the case, it turns out this is a bit more complicated. For self-insured insured clients, this will require coordination between the Plan Sponsor, TPA and PBM in order to report.
Learn more at DrugCostReporting.com