Anthem data request issued

Anthem employer groups recently received an email from Anthem requesting data needed to comply with the Prescription Drug Data Collection (RxDC) reporting requirement. To comply with the Consolidated Appropriations Act (CAA), passed in December 2021, insurance companies and employer-based plans must submit information regarding prescription and health care spending to the Centers for Medicare and Medicaid Services (CMS) by June 1 of each year.  

The majority of the required RxDC data is maintained by the health insurance carrier, but not all. Plan sponsors need to provide data Anthem does not collect:

• average monthly percentage of member-paid premium for 2023
• average monthly percentage of employer-paid premium for 2023
• group name
• group case number
• employer EIN
• Form 5500 plan number (if not applicable enter “N/A”)
• Group contact name and email

Click here to access the Anthem data request.

CMS instructions state the following should be included in the member-paid premium calculation for fully insured and level-funded groups:

• premium paid by members for medical and pharmacy coverage
• member COBRA premium, including the 2% administrative fee
• spousal and tobacco surcharges, if applicable

CMS defines member-paid premium for self-funded groups differently than fully insured groups. Click here for the CMS self-funded calculation.

Failure to complete the data request may require employers to submit information on their own or be subject to a CMS penalty of $100 per day per affected individual.

If you haven’t received the Anthem email notification, contact your Bukaty benefits consultant at 913.345.0440.