SPBA Email Alert:  November 18, 2021

Agencies Release Interim Final Rule - Prescription Drug and Health Care Spending

On Wednesday, November 17, the agencies released an interim final rule (IFR) with request for comments entitled “Prescription Drug and Health Care Spending.” This IFR implements provisions of the Consolidated Appropriations and Act and follows two previous IFRs implementing provisions of the No Surprises Act.

Comments on this IFR are due on January 24, 2022. If you would like to contribute to SPBA’s comments, please contact Erin Reiter at erin@spbatpa.org or Rhonda Reed at rhonda@spbatpa.org.

The new IFR requires plans and issuers in the group and individual markets to submit certain information on prescription drug and other health care spending to the agencies annually, including:

• General information regarding the plan or coverage;
• Enrollment and premium information, including average monthly premiums paid by employees versus employers;
• Total health care spending, broken down by type of cost (hospital care; primary care; specialty care; prescription drugs; and other medical costs, including wellness services), including prescription drug spending by enrollees versus employers and issuers;
• The 50 most frequently dispensed brand prescription drugs;
• The 50 costliest prescription drugs by total annual spending;
• The 50 prescription drugs with the greatest increase in plan or coverage expenditures from the previous year;
• Prescription drug rebates, fees, and other remuneration paid by drug manufacturers to the plan or issuer in each therapeutic class of drugs, as well as for each of the 25 drugs that yielded the highest amount of rebates; and
• The impact of prescription drug rebates, fees, and other remuneration on premiums and out-of-pocket costs.

Plans will be required to submit this information aggregated at the state/market level, rather than separately for each plan. The IFR provides standards and definitions, including for identifying prescription drugs regardless of the dosage strength, package size, or mode of delivery.

The statute requires plans and issuers to begin submitting the required information to the Departments by December 27, 2021, and to submit this information by June 1 of each year thereafter. However, the agencies have previously announced that they will exercise discretion to provide temporary deferral of enforcement and that they will not initiate enforcement action against a plan or issuer that submits the required information for 2020 and 2021 by December 27, 2022.

The CMS factsheet is available here: https://www.cms.gov/newsroom/fact-sheets/prescription-drug-and-health-care-spending-interim-final-rule-request-comments

The full text of the IFR is available here: https://public-inspection.federalregister.gov/2021-25183.pdf

For any questions about this IFR, please contact Erin Reiter at erin@spbatpa.org or Rhonda Reed at rhonda@spbatpa.org.