2025 RxDC Reporting: A Guide for Employers
April 22, 2025
Preparing for 2025 RxDC Reporting: Essential Steps for Employers
As we approach the 2025, June deadline, it’s crucial for employers to prepare for the upcoming RxDC (Prescription Drug Data Collection) reporting. This annual requirement mandates that group health plans and health insurance issuers submit detailed information on prescription drug and healthcare spending to the Centers for Medicare & Medicaid Services (CMS). The next RxDC report, covering data for 2024, is due by Sunday, June 1, 2025.
What is RxDC Reporting?
RxDC reporting involves submitting several files, including:
- Plan-Level Information: Details like plan year dates, enrollment, and premium data.
- Medical and Pharmacy Benefits: Comprehensive data on medical and pharmacy benefits.
Who Submits the Reports?
Most employers rely on third parties, such as issuers, third-party administrators (TPAs), and pharmacy benefit managers (PBMs), to handle the RxDC reporting. It’s common for employers to work with multiple third parties to complete the report. For instance, a self-insured employer might use both a TPA and a PBM to submit different parts of the RxDC report. As long as Centers for Medicare & Medicaid Services receives all required files, the submission is considered complete.
Key Points to Remember:
- Annual Requirement: Health plans and issuers must submit RxDC reports every year.
- Third-Party Assistance: Most employers depend on issuers, TPAs, or PBMs to submit the reports.
- Responsibility: If an issuer fails to submit the report for a fully insured plan, the issuer is at fault. For self-insured plans, the reporting liability remains with the plan, even if a third party is contracted to submit the information.
Action Steps for Employers:
- Reach Out Early: Contact your issuers, TPAs, or PBMs to confirm they will submit the RxDC files by June 1, 2025.
- Review Agreements: Ensure your written agreements with third parties clearly outline their reporting responsibilities.
- Provide Necessary Information: Be prepared to supply plan-specific details, such as enrollment and premium data, to your third-party vendors.
- Monitor Compliance: For self-funded plans, keep an eye on your TPAs’ or PBMs’ compliance with the reporting requirements.
By taking these steps, employers can ensure a smooth and compliant RxDC reporting process, contributing to greater transparency and efficiency in healthcare spending.
Reach out to your Benefits Robertson Ryan Insurance Agent for questions. For more detail and reporting resources, download this Zywave Handout.
*Please note that we rely on independent sources, and recommend conducting further research or to seek guidance from a qualified industry professional, legal counsel, or licensed insurance agent as appropriate for your needs. These blog posts are intended for general informational purposes only.