January 18th, 2023

Still No Surprises at SmithRx: The Consolidated Appropriations Act (CAA) 2021

At SmithRx, we’re all about transparency and passing through savings for prescription drug coverage. Our numerous SmithRx Connect savings programs, direct care to the lowest cost option and pass on savings to our employer groups and members to lower pharmacy spend.  

Unfortunately, not all PBMs share our vision of a world where data about drug costs and rebates is disclosed freely, and medication costs continue to rise for most employer groups. In order to assess the industry and increase transparency, the Consolidated Appropriations Act (CAA) was established in 2021 as part of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The CAA requires insurance companies and employer-based health plans to report on prescription drug and health care spending to numerous federal agencies. For prescription drug spending, the Prescription Drug Data Collection, or “RxDC” report, must be submitted to CMS. Either the employer-based health plan or the PBM can submit the different components of the RxDC, but this must be coordinated to avoid duplicate file submissions.

Information required by the CAA includes spending on prescription drugs; which drugs are prescribed most frequently and which account for the highest spend; drug rebates received from manufacturers; and member payments for premiums and out-of-pocket expenses. Information collected will be used by CMS to identify what is driving rising prescription drug costs across the industry. It also assesses the impact of drug rebates on premiums and member cost-share. This is all an effort to foster transparency in prescription drug pricing across the healthcare industry. CMS will publish findings about drug pricing trends and the impact of rebates.  

Since we’re already aboard the transparency train, SmithRx has no problem complying with the CAA and we are partnering with TPAs to coordinate data collection and submission to CMS on behalf of our employer groups. We will continue to look out for your interests and deliver superior savings for your members. It is unfortunate the industry is in a place where legislation is required to invoke transparency. We welcome a move towards more transparency and simplification in the pharmacy ecosystem.

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Still No Surprises at SmithRx: The Consolidated Appropriations Act (CAA) 2021

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Partnering with SmithRx to provide transparent pharmacy benefits helps us deliver low-cost, high-quality care. Their pass-through model is the best way to ensure prescription drug pricing is fair.

Will Young
CEO at Sana Benefits

My loudest and most challenging group was handled perfectly in the first 30 days post-go-live by SmithRx. If it were up to me, I would put every one of my new groups with SmithRx.

Ken Mensio
Vice President at Risk Strategies

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