Government Defers Prescription Drug Machine-Readable File Requirements Until Further Notice
Elixir Rx Solutions, LLC (Elixir) will not post prescription drug machine-readable files to this site /plansponsors/machine-readable until further notice from the Departments of Labor, Health and Human Services, and the Treasurer (the Departments).
As you know, the Departments published the Transparency in Coverage Final Rules (TIC Final Rules) which requires plans and health issuers to publish three machine-readable files to a public website:
1. In-network Rate File – Reports payment rates negotiated between plans or issuers and providers for all covered items and services.
2. Out-of-network Allowed Amount File – Reports historical actual billed and allowed amounts for covered times or services incurred by out-of-network providers during the 90 days beginning 190 days prior to the publication date of the file.
3. Prescription Drug File* – Reports pricing information for prescription drugs, including the current negotiated rate and historical net price for claims insured during the 90 days beginning 180 days prior to the publication date of the file.
*Note: The Prescription Drug File is the only machine-readable file that applies to Elixir Rx Solutions, LLC (Elixir) business.
The Departments deferred enforcement of the first two machine-readable requirements until July 1, 2022. However, that deferral date to the Prescription Drug File. Instead, the Departments have announced that they will defer enforcement of the requirement that plans and issuers publish the Prescription Drug File, pending further rulemaking. Therefore, Elixir will not publish any files to the site: /plansponsors/machine-readable until further notice from the Departments on the Prescription Drug File.
Elixir will continue to monitor the government updates around this requirement and will share those updates with you. Elixir will partner with you to ensure that we are ready to post your Prescription-Drug Machine readable file to this site /plansponsors/machine-readable upon notice from the Departments regarding an actual enforcement date for the Prescription Drug machine-readable file.
For more information and resources on the TIC Final Rules, visit https://www.cms.gov/healthplan-price-transparency/resources