Section 2.07 - Reporting Prescription Drug Rebates(1)Prescription Drug Rebate Reporting. (a)Reporting Requirements. 1. Payers must report rebate data for all Massachusetts residents for whom the payer has complete pharmacy claim and rebate data.a. If Payers are not able to report data solely for Massachusetts residents, they must notify the Center in writing and propose a different Member population definition for Center approval.b. Any Members for which a Payer has no pharmacy expenditure or prescription drug rebate data, or partial pharmacy expenditure or prescription drug rebate data, should be excluded from this data reporting.2. Payers must report rebate data separately by Medicare, Medicaid, and commercial plans (fully-insured and self-insured), and any other insurance categories as defined by the Data Specification Manual. If rebate data is only available to a Payer at an aggregated level and cannot be separated to provide unique information for each insurance category, the Payer shall report data at the most granular level available. In such instances, the Payer shall report a separate observation with all required data elements for each insurance category using a Combined Rebate Identifier, as specified in the Data Specification Manual.
3. Payers shall report all data in the prescription drug rebate data submission at the aggregate level for all Massachusetts residents, or in the aggregate for any alternative Member population approved by the Center.4. Payers shall report prescription drug rebate and pharmacy expenditure data using IBNR estimates resulting in approximated completed claim and rebate amounts for periods that are not yet considered complete.(b)Required Data Elements. The Center will delineate required data elements in the Data Specification Manual.(2)Pharmacy Benefit Manager (PBM) Reporting. (a)Reporting Requirements.1. Payers must report PBM data separately by Medicare, Medicaid, and commercial plans (fully-insured and self-insured), and any other insurance categories as defined by the Data Specification Manual.2. Payers must identify the level of services performed by each PBM vendor for each insurance category. Payers shall identify the level of services in the following categories: b. Drug Formulary Management;c. Manufacturer Drug Rebate Contracting; ord. any other category defined in the Data Specification Manual. Payers shall identify whether a PBM performed a given service for "all", "some", or "none" of its Members in a given insurance category. Payers may report multiple PBMs in an insurance category.(b)Required Data Elements. The Center will delineate required data elements in the Data Specification Manual.(3)Due Dates: Annual Reports. Each year, Payers must submit: (a) preliminary data for the prior Calendar Year; and(b) final data for the Calendar Year for which the payer submitted preliminary data during the last reporting cycle. Payers shall allow for a claims run-out period of at least 90 days after December 31st of the previous Calendar Year. Final data should reflect at least 15 months of claims run-out. Specific deadlines will be established in the Data Specification Manual.Amended by Mass Register Issue 1363, eff. 4/20/2018.Amended by Mass Register Issue 1431, eff. 11/27/2020.