The purpose of this notice is to provide an update to SBMA clients regarding new regulations currently in effect and future regulations that will be in effect in the next several months.
Below you will find information regarding the Transparency in Coverage Final Rule and the RxDC Report or Prescription Drug Data Collection.
In 2020, the departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage rule requiring health insurers and group health plans provide the following two items.
- Publicly Available Machine-Readable Files: Insurers and plans will be required to make available to the public— including consumers, researchers, employers, and third-party developers—machine-readable files disclosing detailed information on the costs of covered items including negotiated rates for in-network providers, historical allowed amounts and billed chargers for out-of-network providers and negotiated rates, and historic net prices for prescription drugs.
- Consumer Price Comparison Tool: Requires insurers and plans to create online consumer tools that include personalized information regarding members’ cost-sharing responsibilities for covered items and services, including prescription drugs.
Consolidated Appropriations Act (CAA): Congress passed into law the Consolidated Appropriations Act (CAA) requiring insurers and plans to submit cost data on pharmacy benefits and drug costs on an annual basis.
SBMA is making a good-faith effort to ensure all compliance requirements are met in a timely and cost-conscious manner.