Blue Cross and Blue Shield of Kansas City (Blue KC) recently emailed employer groups who had Blue KC coverage for any period in 2023. Blue KC is 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 data required is maintained by Blue KC, but plan sponsors are required to provide several data elements:
- total premium or premium equivalent,
- average monthly premium or premium equivalent paid by the employer on behalf of plan members for 2023 (divide the total by 12, even if coverage wasn’t for a full year),
- average monthly premium or premium equivalent amount paid by members for 2023 (divide the total by 12, even if coverage wasn’t for a full year), and
- confirmation that the plan was self-funded or not (additional questions for self-funded groups address stop-loss coverage).
CMS instructions state the following should be included in the member-paid premium calculation:
- premium paid by members for medical and pharmacy coverage,
- member payments for COBRA coverage, including the 2% administrative fee, and
- spousal and tobacco surcharges, if applicable.
CMS defines member-paid premium equivalents for self-funded groups differently than fully insured groups. Click here for the CMS calculation.
Blue KC’s completion deadline is May 3. Failure to meet this deadline 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 Blue KC email notification, contact your Bukaty benefits consultant at 913.345.0440.
