US Gov’t Takes More Action to Address Rx Drug Pricing

The Biden Administration is taking additional steps to address the cost of prescription drugs by requiring health insurance issuers, employer-based health plans, and other group health plans to report on prescription drug and health coverage costs.

The requirement is being implemented through an interim final rule with request for comments issued by the US Departments of Health and Human Services (HHS), Labor, the Treasury (collectively, the Departments), and the Office of Personnel Management.

The measures require health plans, health insurance issuers offering group or individual health insurance coverage, and health benefits plans offered to federal employees to submit data to the Departments, which will work through the HHS Assistant Secretary for Planning and Evaluation (ASPE) to publish a report on prescription drug pricing trends and rebates, as well as their impact on premiums and consumers’ out-of-pocket costs. The data submission requirements include information on average monthly premiums and drug spending for patients, compared to their employers and/or group health plans/health insurance issuers.

The interim final rule also implements requirements to identify specific cost drivers. Plans and issuers must now provide the Departments with an annual overview of their top 50 drugs across key areas of concern, including:

  • the most frequently dispensed brand prescription drugs,
  • the costliest prescription drugs, and
  • the prescription drugs that had the greatest increase in total annual plan spending over the previous year.

The new data submission requirements will apply starting with data from the 2020 calendar year. However, the Departments say they are deferring enforcement of the new requirements until December 27, 2022, to give regulated entities time to come into compliance. The Departments anticipate releasing their first report in June 2023 and every two years thereafter.

Source: US Departments of Health and Human Services