June 23 -- The Centers for Medicare & Medicaid Services, Internal Revenue Service, Employee Benefits Security Administration, and Office of Personnel Management request public input by July 23, 2021 regarding specification of requirements for health plans and insurers to report pharmacy drug expenditures, as well as the nature of federal reports aggregating the data collected. The RFI poses 41 questions in seven categories.
In recent years, there has been a broad effort toward promoting greater price transparency in health care as a means to promote competition and bring down overall costs. Section 204 of Title II of Division BB of the CAA added parallel provisions at section 2799A-10 of the Public Health Service Act (PHS Act), section 725 of the Employee Retirement Income Security Act of 1974 (ERISA), and section 9825 of the Internal Revenue Code (Code). These provisions include certain reporting requirements for group health plans (plans) and health insurance issuers offering group or individual health insurance coverage (issuers). The reporting requirements primarily relate to prescription drug expenditures, requiring that plans and issuers submit the relevant information to the Departments. The provisions also require the Departments to issue biannual public reports on prescription drug reimbursements under group health plans and individual health insurance coverage, prescription drug pricing trends, and the impact of prescription drug costs on premium rates, aggregated in such a way so that no drug or plan specific information will be made public.
Title I of Division BB also amended 5 U.S.C. 8902(p) to include specified provisions of the CAA into Federal Employees Health Benefits (FEHB) carrier contracts. Although section 204 is not enumerated as a specified provision in section 8902(p), FEHB carrier compliance with the Departments' collection pursuant to this section helps accomplish the CAA's intended purpose of achieving national health data transparency and lower costs. Therefore, references to “plans” for purposes of this request for information include FEHB health benefits plans.
The Departments and OPM are requesting input from the public regarding implementation of the data collection, the data elements to be collected, and the associated impact on plans and issuers. Public input will inform the Departments' and OPM's implementation through rulemaking and establishment of processes to receive the information that must be reported. Using the information obtained through this data collection, the Departments and OPM intend to analyze trends in overall spending on prescription drugs and other health care services by plans and issuers and to publish the analysis in the required reports in a format that the Departments and OPM intend to enable plans and issuers to ultimately negotiate fairer rates and lower costs for participants, beneficiaries, and enrollees.
FR notice requesting information: https://www.federalregister.gov/documents/2021/06/23/2021-13138/request-for-information-regarding-reporting-on-pharmacy-benefits-and-prescription-drug-costs