Consolidated Appropriations Act: Prescription Drug and Health Care Spending Reporting Requirements for Group Health Plans

Under the Consolidated Appropriations Act, 2021 (the CAA), group health plans and health insurance issuers are required to submit certain information related to prescription drug and other health care spending to the Department of Labor, Department of Health and Human Services, and the Department of the Treasury (the Departments). [...]although sponsors of self-funded group health plans may enter into similar agreements with other entities, such as TPAs and PBMs, ultimate liability for the reporting will remain with a plan sponsor of a self-funded plan regardless of the agreement. [...]plan sponsors should ensure that their underlying agreements with TPAs, PBMs and other non-insurer entities cover reporting failures in their indemnity provisions. Items in the second category include: * certain top 50 prescription drug listings * total annual spending on health care services by the plan broken down into smaller categories, i.e., hospital, primary provider/clinic, specialty provider/clinic, drugs covered by pharmacy benefit, drugs covered by medical benefit, and other costs (such as wellness services) * specific prescription drug spending and utilization information * premium amount information (including total premium amount broken down into plan sponsor and participant costs), and * prescription drug rebate, fee, and other remuneration information (including how rebates impact premium and cost sharing amounts).