Reporting of Prescription-Drug Coverage Mandatory in 2020


As of January 1, 2020, responsible reporting entities (RREs) must report prescription-drug coverage to the Centers for Medicare & Medicaid Services (CMS).  Currently, RREs are required to report information to CMS about individuals who are entitled to Medicare and are covered under a group health plan, so CMS may determine whether the plan is primary to (pays before) Medicare.

RREs already have the option to submit primary prescription-drug coverage information as part of their mandatory Medicare Secondary Payer (MSP) reporting, but such information will become mandatory for quarters after January 1, 2020.  Further, the information request will be expanded and include additional questions.

An RRE is the entity that has direct responsibility for processing and paying prescription-drug claims.  ASR Health Benefits is the RRE for the self-funded prescription-drug plans it administers for purposes of the MSP reporting requirements.

Generally, employers will not be involved in this reporting requirement except to assist ASR in collection of the required information.

If you have questions about this new regulation, call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.