Why RxDC Matters
What Is RxDC Compliance?
RxDC, or Prescription Drug Data Collection, is a compliance requirement for health plan sponsors.
It mandates the submission of 10 data files to the Centers for Medicare & Medicaid Services (CMS), detailing medical and pharmacy spending from the previous calendar year.
These files must be submitted annually by June 1st.
Self-Funded Health Plans (SFHPs) are required to:
Submit specific data from the prior Calendar Year
Provide Premium and Member Cost
Complete all submissions by June 1st
Why RxDC is Important
Regulatory Compliance
Ensures
adherence to ACA requirements and prevents potential fines or penalties from CMS for non-compliance
Transparency
Provides plan sponsors with detailed insights into PBM profitability, rebate structures, and drug pricing trends to optimize pharmacy benefits
Audit Readiness
Maintain a documented history of compliance, ensuring preparedness in the event of a CMS audit and supporting financial oversight
Partnering with Rx Data Collection, an Independent RxDC Submission Entity, streamlines compliance while revealing the hidden value within your data
Time to Begin
Uncover hidden pharmacy benefit costs with Rx Data Collection. Stay compliant, gain transparency and take control of your pharmacy spend!
Email [email protected] or click the button below to learn more.
Your Independent RxDC Reporting Entity
Rx Data Collection
Ready for Simple, Money-Saving RxDC Compliance?
Premium Data Submission
We submit your Plan Sponsor Premium Data to meet RxDC compliance, potentially saving you thousands on compliance fees!
RxData Advantage
We collect, analyze, and submit your pharmacy data, providing valuable insights to help you maximize your benefits.
TPA Submission Services
We customize our services for TPAs and healthcare brokers seeking a streamlined process that prevents overwhelming their teams with paperwork.
STILL NOT SURE?
Frequently Asked Questions
You Ask, We Answer
What is RxDC compliance?
RxDC (Prescription Drug Data Collection) compliance requires health plan sponsors to submit 10 data files annually to the Centers for Medicare & Medicaid Services (CMS). These files contain medical and pharmacy spending data for the previous calendar year and must be submitted by June 1st of the following year.
Who is required to submit the data?
Health plan sponsors are responsible for submitting the required data. However, for insured health plans, the responsibility is shared with the insurance carrier. In many cases, Third-Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) submit some or all of the data on behalf of the plan sponsor.
When did RxDC Compliance begin?
The first RxDC submissions covered Calendar Years 2020 and 2021, with reports due to CMS by December 31, 2022. Starting with Calendar Year 2022, submissions are required annually by June 1st of the following year.
Why is my Carrier/TPA requesting Employee Premium Data?
One of the required RxDC files (D1 - Premium and Life Years) requires plan sponsors to report:
The Average Monthly Premium Paid by Members
The Average Monthly Premium Paid by Employers
Since most carriers and TPAs do not bill premiums directly to members, they rely on plan sponsors to provide this information. For help calculating these amounts, click [here].
I work for a plan sponsor and have never heard of RxDC or been involved in any submissions. What should I do?
Self-funded plan sponsors who have not been involved in RxDC submissions should take the following steps:
Contact your TPA and PBM to confirm how they have managed compliance in past years.
Reach out to us at [email protected] for expert guidance and assistance.
In rare cases, an insurer may have completed the submission without contacting the plan sponsor, but it’s always best to confirm compliance in writing.
Does my health plan need to submit data if we self-administer the medical or pharmacy portion of our healthcare benefits?
Yes. All non-federal government health plans are required to comply with RxDC through annual submissions. If assistance is needed with file preparation and submission, our team at Rx Data Collection can help. Contact us at i[email protected] for support.
Is there an advantage to submitting RxDC data directly instead of relying on the PBM?
Yes. PBMs have traditionally not disclosed key data required by RxDC, such as drug margins and rebate details. Additionally, maintaining multiple years of RxDC data helps track spending trends, which is critical for controlling drug plan costs.
How can Rx Data Collection collect, analyze, and submit my data at no cost to the plan sponsor?
Many PBMs set aside contractual funds to cover external costs related to the pharmacy benefit. In most cases, Rx Data Collection can access these funds, which often go unused, to cover the full cost of RxDC compliance for the plan sponsor.
Get In Touch
Assistance Hours
Mon – Sat 9:00am – 5:00pm
Sunday – CLOSED
Email:
Phone:
(716) 249-0689