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The No Surprises Act, a provision of the Consolidated Appropriations Act (CAA) of 2021, is designed to protect patients from surprise medical billing by limiting their out-of-pocket costs for emergency and other unexpected medical care.

Several provisions of the CCA have new requirements with various effective dates beginning December 2022.

RxDC Reporting

Under the CAA, employers and health insurance plans are required to report certain information about their prescription drug coverage and pricing to the Department of Health and Human Services (HHS) using the RXdc system.

A new yearly prescription drug and health care spending data submission obligation, known as the Prescription Drug Data Collection (RxDC) report, is now applicable to all employer-sponsored medical plans, whether fully insured or self-insured. Reporting is required by December 27,2022, for the calendar years 2020 and 2021.

Employers who have fully insured plans can rely on their insurance carrier to submit this report. Employers with self-insured or level-funded plans should confirm that their pharmacy benefit manager (PBM) or third-party administrator (TPA) will file the report on their behalf.

The information in this report may include details about the types of prescription drugs covered by the plan, the cost-sharing requirements for those drugs, and any changes to the plan’s prescription drug coverage or pricing.

The purpose of the RXdc reporting requirements is to help improve transparency and competition in the prescription drug market, and to help reduce prescription drug costs for consumers.

Patient Protections Against Surprise Billing:

By the first day of the plan year starting on or after January 1, 2023, all employers who maintain a public website for their group health plan must post a new version of the Surprise Billing Notice. Employers who don’t have a public group health plan website should make sure the insurance company or TPA posts the Notice on their public plan website. The CMS No Surprises Act website provides a sample Surprise Billing Notice.

Price Comparison Tool

Effective Jan 1, 2023, health insurers must provide a self-service internet-based price comparison tool that discloses the individualized price and cost-sharing liability for covered goods and services, including prescription medicines.

Upon request, plans and issuers must provide this information in telephonic or paper form. For the provision of this tool, most employers may rely on their insurance carrier for fully insured plans or TPA for self-insured/level-funded plans.

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