RxDC Report Content
- D1: Plan information (plan type, enrollment, premiums)
- D2: Spending by category (hospital, physician, pharmacy, etc.)
- D3: Top 50 most costly drugs by total spending
- D4: Top 50 most frequently dispensed drugs
- D5: Top 50 drugs with the greatest increase in spending
- D6: Prescription drug rebates, fees, and other remuneration
- D7: Impact of rebates on premiums and cost-sharing
- D8: Average monthly premium per enrollee
Delegation to PBM/TPA
For self-funded plans, the employer is responsible for RxDC compliance — but most employers delegate this to their PBM or TPA. Confirm your PBM or TPA is submitting RxDC reports on your behalf and obtain written confirmation of submission. The employer remains responsible even if the PBM or TPA fails to submit.
RxDC Penalties
Compliance Note
Failure to submit RxDC reports can result in civil monetary penalties of $100 per day per affected individual. For a plan with 500 members, a 30-day failure to submit would result in penalties of $1.5 million. Confirm your RxDC reports are submitted on time each year.