Consolidated Appropriations Act, 2021 (CAA)

The Consolidated Appropriations Act, 2021 is the federal spending law, signed in December 2020, that carried the biggest set of employer health plan rules since the Affordable Care Act. It contains the No Surprises Act, which ended most surprise medical bills. It bans gag clauses, so a plan sponsor can no longer be barred by contract from seeing its own claims and prices. It requires plans to report prescription drug spending to the government every year (RxDC). And it requires brokers and consultants who earn $1,000 or more from a plan to disclose their compensation in writing before the contract is signed.

What the law changed for an employer is the word "fiduciary." Under ERISA, a plan sponsor has always been required to run the plan prudently and in the members' interest. Before the CAA, sponsors could honestly say they could not see the data. Now they can demand it, they must attest every December that no gag clause blocks them, and they must sign the RxDC filing. Since 2023, employees have sued Johnson & Johnson, Wells Fargo, and others claiming the companies overpaid for drugs they could have seen were cheaper. Whatever happens in those cases, the argument only exists because the CAA put the numbers within reach.

The takeaway: if you sponsor a plan, three dates matter: the gag clause attestation each December 31, the RxDC filing each June 1, and the broker compensation disclosure before any renewal. Each one is also a moment to ask for the data the law says you can have.