Beginning next year, group health plans (GHPs), including Medicare Secondary Payers, are required to follow the Substance Use – Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT Act) rules on reporting on prescription drugs and coverage. Current group health plan (GHP) reporting requirements are focused on exchanging drug coverage information in order to coordinate benefits under Medicare Part D.

Starting January 1, 2020, GHP Responsible Reporting Entities (RREs) must report primary prescription drug coverage information for Medicare beneficiaries who have coverage other than, or in addition to, Medicare Part D. This requirement includes coverage for someone who is Medicare eligible but currently employed or someone who has a spouse or family member through whom they have coverage. If an RRE is scheduled to submit their report after January 1, then that report will need to include prescription drug coverage that is in effect after the first of the year, even if most of their reporting covers the previous year.

For purposes of SUPPORT Act reporting, who is considered an RRE depends on how a plan’s prescription drug coverage is structured. The entity with direct responsibility for processing and paying the claims is not necessarily the RRE as it may be the GHP itself and not the subcontracted pharmaceutical benefit plan. The RRE will be required to submit an MSP Input File that complies with their reporting requirements. This file allows GHPs to report medical and hospital coverage as well as prescription drug coverage and will comply with the SUPPORT Act.

Basic vs. Expanded Reporting

The MSP Input file and Section 111 allow for both basic and expanded reporting. The basic option is designed to supply hospital and medical coverage information and can be used to supply prescription drug coverage information. The basic reporting option generally complies with the requirements of the SUPPORT Act. Expanded reporting covers the same information but also allows drug coverage information to be reported using a non-MSP Input File.

For RREs that are already reporting using the MSP Input file, whether or not they are currently including pharmaceutical information, no testing is required. However, testing is always welcome to ensure a smooth transition for including this new information. RREs that have not previously submitted are required to submit a test as part of their registration process.

It’s also important to know that RREs are required to resend any incorrect information as part of their next quarterly submission. However, there is no requirement to retain any information returned on the MSP Response File. RREs may choose to store Medicare information from the MSP Response File for their own internal use.