Payers, employers and other group health plan sponsors must report prescription drug and health coverage costs for consumers under a federal regulation released Wednesday.
Plans and issuers must start reporting by December 27, 2021 and submit their information each subsequent year by June 1. 27, 2022.
The Interim Final Rule is the fourth regulation to date implementing the No Surprises Act. The Department of Health and Human Services, the Department of Labor, the Department of the Treasury and the Bureau of Personnel Management issued the regulations.
“Prescription drugs that save lives shouldn’t cost anyone their savings,” HHS Secretary Xavier Becerra said in a press release. “Today, the Biden-Harris administration is taking additional steps to make healthcare more accessible and affordable for patients. By collecting key data on prescription drug costs, we promote competition and transparency in the healthcare industry as we continue to contain rising costs. of drugs and surprise medical bills. “
In addition to general information on their listing and total health spending, payers and issuers in individual markets will be required to submit information on prescription drug spending to each of the federal departments implementing the rule, including premiums. monthly averages paid by employees versus employers.
Plans and issuers will also be required to report the 50 most frequently dispensed brand-name prescription drugs, the 50 most expensive prescription drugs by total annual expenditure, and the 50 prescription drugs including plan or health spending. coverage increased the most strongly compared to the previous year. Prescription drug discounts and fees paid to the plan or to the issuer by the manufacturers in each category of therapeutic products will also need to be reported, along with the impact of such discounts and fees on premiums and out-of-pocket expenses.
Plan sponsors, issuers and carriers of the federal employee health benefits program will submit this information at the state or market level rather than separately for each plan, according to CMS.
Once this information is submitted, the HHS will issue a report on prescription drug price trends and discounts and their impact on costs to consumers. The administration expects these reports, which will be updated twice a year, to clarify the role of prescription drugs in increasing health care spending and costs.
The rule notes that the information will also offer insight into competition and market concentration in the pharmaceutical and healthcare industries. The data can help the administration fight high prices driven by industry concentration and other anti-competitive behavior, which President Joe Biden pledged to fight in an executive order issued in July.
Wednesday’s prescription drug transparency policy is part of the administration’s implementation of the No Surprises Act, passed by Congress as part of last year’s year-end spending program. The law aims to ensure that patients only pay network tariffs for off-grid emergency services or air ambulance travel. Payers and suppliers will have 30 days to settle any discrepancies and any outstanding invoices will go through an arbitration process.
Stakeholders reacted with skepticism of the policy to outright opposition to it, nor did they appreciate the way the administration chose to implement the policy. Lawmakers with medical degrees also criticized the implementation, saying it went against Congress’ intent on the No Surprises Act.
The first implementing rule for the No Surprises Act, released in July, banned surprise medical bills for emergency services, air ambulance services, and some non-emergency services. Throughout the fall, the Biden administration released further policies defining the dispute resolution process and requiring regimes and issuers to submit information about air ambulance services and require officers to disclose the ‘compensation for the registration of people for certain health coverage.
The Association of Air Medical Services sued the federal government on Tuesday to block the regulations.
Comments on Wednesday’s provisional final rule are expected by January 24.