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Improving the Transparency and Oversight of Prescription Drug and Medical Costs

Prescription medications account for a major portion of the cost of healthcare for Americans. Recent efforts by the Biden-Harris administration are aimed to increase transparency of drug costs and to potentially lower costs for consumers. A number of parties in the healthcare field will be required to provide data in order to assess where we are and how to move towards more affordable healthcare.

Healthcare Providers and Insurers Will Collect and Submit Information

Stakeholders such as health insurance issuers who offer individual insurance coverage, group insurance coverage, and health benefits plans for federal employees will need to submit key data regarding prescription costs. The HHS Assistant Secretary for Planning and Evaluation (ASPE) intends to publish a report that details prescription drug pricing trends and rebates, and how they impact both insurance premiums and the out-of-pocket costs paid by individuals.

Information required for the report will include data on average monthly premiums and drug spending for patients, as compared to what their employer’s insurers are paying for this care.

Annual Reports Will Guide Future Policy

Health Plan issuers will need to report annually on their top 50 prescribed drugs. Information sought going forward will include the most frequently prescribed brands, the most expensive prescription drugs, and which prescriptions accounted for the greatest increases in spending year over the year.

Additionally, information on fees, prescription drug rebates, and other payments to health plans, insurance issuers, and pharmacy benefit managers will be used to help the relevant federal departments understand and analyze prescription drug costs and the ways those costs fluctuate over time. Policymakers are especially interested in data involving the top 25 drugs that generate the highest rebates.

Learning About the Requirements

Details about the data submission requirements and how the collected data will be analyzed have been assembled in a fact sheet issued by the Centers for Medicare and Medicaid Services.

Affected organizations are required to begin submitting data starting with the 2020 calendar year. Organizations have some time to get the information together. The Departments have deferred enforcement of the new requirements until December 27, 2022. This gives regulated entities the time they need to gather the required information.

As a result, the information required for both 2020 and 2021 will be due December 27, 2022.

More Information Coming in the Future

It will take some time to analyze the information and begin assembling reports on the drug costs that are affecting patients the most. The Departments say they plan to release their first report in June 2023. After that, reports will be released every other year, which means the second report is expected in 2025.

As more data is accrued, new rules are expected to be released. Over time, it is hoped that the information gathered will help regulators better understand pricing and premium trends in order to achieve the goal of more accessible, low-cost, and comprehensive care.

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