March 2024 Market Edge News for All Segments

2024 Prescription Drug Data Collection (RxDC)

This article includes clarifications to our instruction for the RxDC submission process. Please note, both Fully Insured and Self-funded customers must submit their data through our online form by May 1, 2024. We apologize for any confusion our initial communication may have caused.

Please refer to our FAQ for answers to specific questions relating to RxDC. As we have in previous years, we will continue to amend and update this FAQ (AmeriHealth, AmeriHealth Administrators) with the date marked in red.

For the June 1, 2024 Section 204 RxDC submission to the Centers for Medicare & Medicaid Services (CMS), AmeriHealth and AmeriHealth Administrators must report the actual premium amounts paid by the employer versus the actual premium amounts paid by members in 2023.

To obtain the employee contribution information, AmeriHealth and AmeriHealth Administrators will be requesting the information via this online form.

Information collected will include:

  • Yearly total employee contribution based on the type of product the customer offers (HMO or PPO).
  • For self-funded customers who submit Form 5500, the Form 5500 plan number
  • For self-funded customers that carve out prescription drug benefits, the pharmacy benefit manager (PBM) name and EIN
  • We ask that information be submitted by May 1.

As a reminder, AmeriHealth and AmeriHealth Administrators will produce and submit files P2, D1, and D2 for both insured and self-funded customers based on the data they currently have within their systems for the timeframes required for the reports. If a self-funded customer has OptumRx as their PBM, OptumRx will provide files D3 through D8 to AmeriHealth and AmeriHealth Administrators. AmeriHealth and AmeriHealth Administrators will submit all files on behalf of insured customers.

Please note: Fully Insured and Self-funded customers are both required to submit our online form with their group data.

AmeriHealth and AmeriHealth Administrators will submit all files to CMS in one reporting package. For self-funded customers that carve out prescription drug benefits, data for files D3 through D8 will not be included.

We will not be sending RxDC communications directly to customers. We ask you please relay RxDC information to our mutual clients.

Please note, we have adjusted the language on drop down questions on the form. We are collecting the Total Employee Contribution, so we can calculate employer contribution. We apologize for any confusion.

Please contact your account representative with any questions.