RxDC Reporting Requirements – FORM D1

FORM D1 – Editable PDF

Click here to open the editable FORM D1 PDF document.

Click here to access the RxDC Reporting Data - Illustrative Calculations document for guidance on how to calculate the required fields in FORM D1.

Upon completion of FORM D1, save document and email to Benecard at BCSCAA@benecard.com no later than April 8th, 2025.

Benecard will submit the information to CMS by June 1st, 2025.

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