CMS Rule Would Require Payers to Share Data on Drug Spending

The Biden administration has issued an interim final rule that requires group and individual health insurance market plans to send data related to prescription drug spending of both patients and their employers or health plans as well as average monthly premiums.

Health plans will send the data to the Departments of Health and Human Services (HHS), Labor, the Treasury so that they can compile a report on prescription drug pricing. The report will also address how drug pricing influences premiums and out-of-pocket healthcare spending.

Health plans will offer an annual overview of their top 50 drugs in at least three categories. The categories include most frequently dispensed brand drugs, highest cost drugs, and drugs that boost year-over-year plan spending.

The data would be due by December 27, 2021 and by June 1 every year after 2021, although these deadlines have some flexibility in the first year. This is the fourth interim final rule related to the No Surprises Act and the Consolidated Appropriations Act (CAA), 2021.

“Life-saving prescription drugs should not cost anyone their life savings,” said HHS Secretary Xavier Becerra. “Today the Biden-Harris Administration is taking additional steps to make health care more accessible and affordable for patients. By collecting key data on the costs of prescription drugs, we are promoting competition and transparency in the health care industry as we continue to curb the rising costs of drugs and surprise medical bills.”

Health plans will be able to access more information on the submission requirements in a CMS fact sheet. The unpublished rule is available on the Federal Register. 

“With today’s rule, we’re taking more steps to make sure that the care people receive is affordable,” said CMS Administrator Chiquita Brooks-LaSure. “Expanding on our earlier efforts to implement the No Surprises Act, we will monitor pricing and premium trends to better identify barriers to the low-cost, comprehensive, and person-centered care we all deserve.”

Comments on the interim final rule with request for comment will be due January 24, 2022.