Why RxDC Matters
What Is RxDC Compliance?
RxDC stands for Prescription Drug Data Collection. It means sharing drug spending and usage data with CMS.
Self-Funded Health Plans (SFHPs) do this to:
Find better vendor pricing
Control rising drug expenses
Shape benefits to fit real-world member needs
Why Should I Care?
RxDC data unlocks:
Mixed Drug Insights
Learn how brand, generic, and specialty meds stack up
Cost Trends
See what’s driving higher drug bills so you can cut back
Usage Clues
Spot which meds are used most, then optimize your plan
These insights can help you save hundreds—sometimes thousands—over time by exposing hidden costs.
Time to Begin
Stay informed and keep your plan’s bottom line healthy.
Email us at [email protected] to learn more.
Your Independent RxDC Reporting Entity
Rx Data Collection
Ready for Simple, Money-Saving RxDC Compliance?
Premium Data Submission: $400
We submit your Plan Sponsor Premium Data to meet RxDC compliance, potentially saving you thousands on compliance fees!
Strategic Submission: $1,500
We collect, analyze, and submit your pharmacy data, providing valuable insights to help you maximize your benefits.
TPA Submission Services
We build and submit RxDC files for TPAs and Plan Sponsors with no fuss, so you can focus on what you do best.
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.