Washington, DC – The ERISA Industry Committee (ERIC), along with HR consulting and asset management firm Mercer, responded to a Request for Information (RFI) issued by the U.S. Departments of Treasury, Labor, and Health and Human Services regarding new employer requirements related to the interim final rules on reporting on pharmacy benefits and prescription drug costs.
ERIC and Mercer previously submitted joint comments to the Departments on these requirements in July 2021. ERIC’s and Mercer’s latest comments are in response to the Departments’ request for additional information from stakeholders and provide recommendations to the Departments on how best to address compliance challenges facing plan sponsors with ERISA plans, including:
- Revising the interim final rules to confirm that the Consolidated Appropriations Act of 2021 Section 204 “Reporting on pharmacy benefits and drug costs” data is subject to Section 202 “Disclosure of direct and indirect compensation for brokers and consultants to employer-sponsored health plans and enrollees in plans on the individual market”
- Imposing reasonable cooperation requirements for pharmacy benefit managers (PBMs), third-party administrators (TPAs), and insurers regarding the reporting obligation
- Providing good faith compliance relief for plan sponsors relying on PBMs, TPAs, and insurers to submit their data
- Updating the RxDC module in the Health Insurance Oversight System to send a confirmation notice to plan sponsors when a report is successfully submitted
The comment letter highlights how some employer-sponsored medical benefits – such as standalone telehealth plans – provide insignificant coverage of prescription drugs. Requiring these plans to report prescription drug information would be burdensome, statistically inconsequential, and not beneficial to the Departments.
Additionally, the comments encourage the Departments to provide explicit guidance on cost-sharing assistance, copay assistance cards, and wellness services. Furthermore, the comment letter requests that outpatient hospital and physician-administered drugs under the medical benefit be omitted from the initial reporting request since the reporting requirements are extremely complex, and more consistency is needed.
“ERIC appreciates the Departments’ efforts to streamline employer requirements related to reporting on pharmacy benefits and prescription drug costs. We believe our comments provide a path that will allow plan sponsors and pharmacy benefit managers to provide the government with accurate, up-to-date information in the most cost-efficient and timely manner,” said James Gelfand, Executive Vice President of Public Affairs, ERIC.
Click here to read the comment letter.