America's Benefit Specialist March 2023

IS IT JUST THE ACRONYMS OR IS IT ALL CONFUSING TO EMPLOYERS? Diving into the New Requirements of Benefit Reporting, Part 2

by Dorothy M. Cociu, RHU, REBC, GBA, RPA, LPRT President, Advanced Benefit Consulting & Insurance Services Fullerton, California dmcociu@advancedbenefitconsulting.com

Whether you are fully insured or self-funded, you have responsibilities for compliance with the CAA Pharmacy Reporting rules. Section 204 of Title II of Division BB of the CAA added parallel provisions at section 9825 of the Internal KEEP AN EYE OUT FOR EMAILS OR LETTERS OR NOTICES ON BILLINGS OF ITEMS RELATED TO THE CAA PHARMACY-REPORTING REQUIREMENTS.

Revenue Code, section 725 of ERISA and section 2799A–10 of the Public Health Service Act. The law requires group health plans and health insurance issuers offering group or indi vidual health insurance coverage to annually submit to the Departments certain information about prescription drug and healthcare spending. Reports are submitted to CMS, and CMS will then publish findings about prescription drug pricing trends and the impact of prescription drug rebates on patient out-of-pocket costs. The goal is to provide valuable information about compe tition and market concentration in the pharmaceutical and healthcare industries. Policymakers can use the prescrip tion-drug and healthcare-spending data to make informed decisions, including identifying any excessive pricing of prescription drugs driven by industry concentration and monopolistic behaviors, promoting the use of lower-cost generic drugs, and addressing the impact of pharmaceutical

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