Expansive New Health Care Reporting Requirements for Employer Plans

November 19, 2021

A new Interim Final Rule (IFR) on prescription drug and health care spending transparency will require employers to quickly renegotiate their third-party administrator contracts to ensure their health plans meet the rule’s extra reporting requirements.

The extra requirements in the IFR that are not in the statute include reporting the following by each state in which an employer plan has participants:

  • Detailed prescription drug data and health care service cost data;

  • The number of plan participants with a paid prescription drug claim;

  • The total dosage units of prescription drugs dispensed and number of paid drug claims;

  • Plan premium amounts;

  • Prescription drug rebates, fees, and other remuneration (broadly defined) broken down by the amounts received by the plan and the amounts passed through to participants for each therapeutic class of drugs; and

  • The impact of prescription drug rebates, fees, and other remuneration on premiums and out-of-pocket costs.

While the first report is due December 27, 2021, DOL will not initiate enforcement actions against employers if they submit data for 2020 and 2021 plan years by December 27, 2022.

Employer plans are responsible for reporting any data their TPAs fail to provide. DOL expects self-insured employers will modify their contracts to require the TPAs to submit the data on their behalf and/or provide the data for the employer to report. 

The pharmacy reporting requirements in the House Build Back Better bill would help employers obtain the data if enacted.  The bill would prohibit supply-chain contracts that limit the disclosure of pharmacy data to employer plans.  It would also impose additional drug reporting that will require employers to re-renegotiate their TPA contracts in 2022 should the provisions remain in the final legislation.

Meanwhile, HR Policy signed on to a letter supporting the first two interim final rules for the No Surprises Act which guide the independent dispute resolution process to consider the qualifying payment amount as the primary factor when determining payment amounts.