Prescription Drug Data Collection (RxDC) reporting

The Consolidated Appropriations Act (CAA) requires health insurers offering group or individual health coverage and self-funded or administrative services only (ASO) group health plans to annually report data about prescription drugs and health care spending to the Departments of Health and Human Services, Labor, and Treasury (Tri-Agencies) (hereinafter the “RxDC Report”). This information must be submitted through the Health Insurance Oversight System (HIOS) via the Centers for Medicare & Medicaid Services (CMS) Enterprise Portal. This reporting is required under Section 204 of Division BB, Title II (Section 204) of the Consolidated Appropriations Act, 2021 (CAA).

If you miss the March 31, 2026, deadline to submit the RxDC survey to Blue Cross NC, the group, or another reporting entity (another vendor or carrier), must submit D1 and P2 data elements directly to CMS via the HIOS platform. Failure to provide the requested information by the deadline will impact your plan’s compliance with this mandate, and your group accepts any risk arising from its failure to provide reporting data.

Review our coverage guides to find out how to submit your required group data.

Blue Cross NC does not have prescription drug data for fully insured groups. We must receive this information through the electronic survey.

If your group is subject to ERISA and filed a Form 5500 in 2025, please provide your Plan’s Form 5500 number. This applies only to certain large group health plans.

To support groups who choose to submit their own RxDC data to CMS through HIOS, please ensure the following employer identification numbers (EINs) are included in your submission:

Pharmacy benefit manager (PBM) information

• PBM name: Prime Therapeutics LLC
• PBM EIN: 26-0076803

Health plan

• Blue Cross NC EIN: 56-0894904

The RxDC report requires information about group health plans that may not appear in the Blue Cross NC system if your group uses other vendors for certain benefits. For example, your group may use a different carrier for PBM, behavioral health, wellness programs, or stop-loss coverage.

If your health plan has any of these carve out arrangements, additional information will be required. Groups with carve-out vendors or carriers will need to coordinate directly with those partners to ensure all necessary data is included.

BlueTPA ASO groups are responsible for submitting their RxDC filing directly to the appropriate regulatory agency. Neither Blue Cross NC nor Brighton Health Plan Solutions will file the RxDC on the group’s behalf.

• Blue Cross NC will provide the D2: Spending by Category report with the required medical data by May 15, 2026.
• The appropriate EIN to submit is Blue Cross EIN number: 56-0894904.

BlueTPA ASO groups must obtain the necessary pharmacy data from their PBM or request that their PBM file the submission on their behalf.

The deadline for the 2025 reference year report is June 1, 2026. If you need additional information and instructions for filing, visit the Prescription Drug Data Collection (RxDC)⁠ page on CMS.gov.

If your group uses Blue Cross NC as its PBM, Blue Cross NC will provide CMS with prescription data in aggregate for all groups. Here's the data we'll submit.

Blue Cross NC will submit the appropriate narrative statement(s) for each data file submitted and will also explain the required information as it relates to aggregate data provided to CMS on behalf of all groups. Blue Cross NC is unable to customize the narrative by group given the nature of the permitted aggregate submission.