Consolidated Appropriations Act (CAA) RxDC Reporting

Optima Health continues to review the requirements under the Consolidated Appropriations Act (CAA). We are on track to meet these deliverables according to the required timelines with the first report due no later than December 27, 2022.

The required data submission is referred to as the RxDC report, Rx meaning prescription drug, and DC meaning data collection. The CAA requires insurance companies and employer-based health plans to submit information regarding the following:

  • spending on prescription drugs and healthcare services
  • prescription drugs that account for the most spending
  • drugs that are prescribed most frequently
  • prescription drug rebates from drug manufacturers
  • premiums and cost-sharing paid by members

As such, Optima Health will file prescription data for 2020 and 2021 on behalf of our fully insured and self-funded employer groups as provided by OptumRx®. Optima is unable to support filing these reports for our large self-funded groups with prescription benefits offered through third-party Pharmacy Benefit Managers.

Optima Health will also compile and file the required medical reporting for plans on behalf of our fully insured and self-funded employer groups. The data submitted will be aggregated at the issuer and third-party administrator level rather than at the group level. At the appropriate time, your Optima Health representative will contact our large self-funded clients to confirm that they want Optima Health to file the medical data on their behalf.

As further information emerges, Optima Health will provide additional details outlining the levels of assistance, related costs, and other information needed to submit these reports.

More details on the regulations and requirements can be found on the CMS RxDC website and frequently asked questions.