Prescription Drug Reporting under CAA


Under the Consolidated Appropriations Act, 2021, self-funded group health plans are required to submit certain information related to prescription drug and other health care spending to the Department of Labor, the Department of Health and Human Services, and the Department of Treasury (Departments).

Plans Required to Report: All group health plans must report the required information (except for church plans).  Reporting requirements do not apply to excepted benefits, however, nor to retiree-only plans with fewer than two participants who are current, active employees.

Due Dates: Reporting will run on a calendar-year basis, with a reporting year referred to as a “reference year” (i.e., the prior calendar year).  The first report is due December 27, 2022 and must include data for the 2020 and 2021 reference years (calendar years).  Thereafter, the due date is June 1 of the year following the end of the reference year.

Reporting Elements: The following information must be reported for each plan:

  1. The beginning and end dates of the plan year
  2. The number of participants and beneficiaries
  3. Each state in which the plan is offered
  4. The 50 brand prescription drugs most frequently dispensed (including their number of paid claims)
  5. The 50 costliest prescription drugs by annual spend (plus the annual spend amount for each)
  6. The 50 prescription drugs with the greatest increase in plan expenditures over the previous plan year, including the change in amounts expended by the plan for each of those drugs
  7. Information about total spending on health care services
  8. The average monthly premium paid by employers and participants
  9. The impact on premiums of rebates, fees, and other similar remuneration paid by drug manufacturers to the plan with respect to prescription drugs, including the amounts paid for each therapeutic class of drugs and the amounts paid for each of the 25 drugs that yielded the highest amount of rebates and other compensation under the plan during the plan year
  10. Any reduction in premiums and out-of-pocket costs associated with rebates, fees, or other remuneration described in #9 above

The Departments will issue biannual public reports on prescription drug reimbursements under group health plans, prescription drug pricing trends, and the impact of prescription costs on premium rates.

Next Steps: ASR is coordinating efforts with our PBM partners to meet the prescription-drug reporting requirement on behalf of our clients.  The Departments have confirmed that multiple vendors may submit data for one plan, provided they do not submit the same data.  Plan sponsors should check if their PBM requires them to affirmatively elect the PBM to file the data on behalf of the plan.  ASR does not require this step.

Contact ASR Health Benefits at (616) 957-1751 or (800) 968-2449 for more information.