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New Rule Aims to Account for Rx Drug Costs in Health Care Spending

On Nov. 14, the Department of Health and Human Services (HHS) released a fourth interim final rule to implement the No Surprises Act. This rule implements new requirements for health plans and health insurance issuers in the group and individual markets to submit information about prescription drugs and health care spending.

HHS aims to issue biennial public reports on prescription drug pricing trends and the impact of prescription drug costs on premiums and out-of-pocket costs starting in 2023. The goal is to enhance transparency and provide insight into how prescription drugs contribute to the growth of health care spending and the cost of health coverage.

This rule requires plans and issuers to submit this information on an annual basis:

  • 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.

Submission of this data was supposed to begin Dec 27, 2021, and on Jun. 1 every year thereafter. However, HHS will provide a temporary deferral of enforcement with regard to the Dec. 27, 2021, and Jun. 1, 2022, deadlines; submission now will be required beginning Dec. 27, 2022. Comments on this rule are due Jan. 24, 2022.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Julie Kozminski is a senior policy analyst at America's Essential Hospitals.

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