RxDC 2025: Frequently Asked Questions and Survey Instructions
Frequently Asked Questions
Why is Blue KC asking employers to complete this form?
The Consolidated Appropriations Act (CAA), 2021, contains a provision requiring insurance companies and employer-based health plans to submit information about prescription drugs and health care spending on an annual basis. This data submission is called the Prescription Drug Data Collection (RxDC) report and is due to the Centers for Medicare & Medicaid Services (CMS) by June 1, 2025, for the 2024 reporting year.
Where do employers find their Blue KC Group ID?
There are three options for finding and verifying your 8-digit Blue KC Group ID:
- Blue KC Employer Portal: Log in to your Blue KC Employer Portal. Visit the Billing tab. Your Group ID will be located next to your Group Name in parentheses.
- Ex: ABC Company (12345678)
- Blue KC Premium Billing Platform: The landing page will display the group ID next to your employer group name.
- Blue KC Premium Billing Invoice: The “Invoice Level” line item, found under your Group Name and Address, provides your Group ID / Sub Group ID (ex: 12345678 / 0001). Only your Group ID, underlined in this example, is required for log in to this survey.
Who will be submitting the information to CMS?
Blue Cross and Blue Shield of Kansas City (Blue KC) will submit on behalf of insured and self-funded groups who were active with Blue KC at any point during the applicable reference year for which it has data. Blue KC does request groups complete a survey to gather certain data possessed by the plan sponsor or employer.
What if the employer had another carrier’s insurance for part of the year?
If the group was active at any point during the reference year (2024), they will be part of Blue KC’s RxDC submission.
Why is Blue KC asking for 2024 data?
CMS requires us to provide 2024 data supporting prescription drugs and health care spending on an annual basis. This request for information supports the 2024 reporting year which is required to be delivered to CMS by June 1, 2025. We will need to get this information from employers every year.
What if the employer terminates?
If a group is currently terminated but was with Blue KC at any point in 2024, the group will receive a survey, and Blue KC will submit RxDC on the group’s behalf for the services we provided in 2024.
What if the employer does not provide Blue KC with this information?
Information from the survey will be used to complete the D1 filing for RxDC. The group may have to submit that information directly to CMS if they do not provide this information to Blue KC via the survey.
Survey Instructions
Please respond to each question for plan year 2024. You are required to provide this data in whole numbers versus decimal values. The survey is specific to each group and can only be completed by one person.
All groups are required to provide the following:
- Annual Premium Paid by Employer: Enter Total Annual Premium or Premium Equivalent Amount Paid by Plan Sponsor/Employer on behalf of Members
NOTE: Blue KC will divide the annual amount by 12 to determine average monthly amount paid by employer - Annual Premium Paid by Members: Enter Total Annual Premium or Premium Equivalent Amount Paid by Members
NOTE: Blue KC will divide the annual amount by 12 to determine average monthly amount paid by members - Total Annual Premium Paid 2024: Confirm the Calculated Total Annual Premium or Premium Equivalent amounts Paid in 2024
NOTES: Blue KC will calculate Total Annual Premium Paid 2024 using:- Annual Premium Paid by Employer + Annual Premium Paid by Employee
- Blue KC will divide the annual amount by 12 to determine average monthly amount paid by employer
Self-funded groups only: If you purchased stop-loss insurance through a carrier other than Blue KC, the survey allows you to submit the amount paid to the other carrier.
- If you do not submit through Blue KC’s survey, you may be required to submit this amount separately.
Calculation Methodology:
- Total Annual Premium or Premium Equivalents Paid by Employer
- Report the total annual premium (or premium equivalents) paid by employers or other plan sponsors on behalf of members in 2024.
- Include:
- Premium or premium equivalents paid by employers and other plan sponsors on behalf of members (including dependents) for medical and pharmacy coverage.
- Premium or premium equivalents paid by group trust, association, or MEWA plans if separate employers or other plan sponsors make premium contributions.
- Exclude: Premium or premium equivalents paid by members.
- Total Annual Premium or Premium Equivalents Paid by Members
- Report the total annual premium (or premium equivalents) paid by members in 2024. Blue KC will divide this number by 12 to determine the average monthly amount for the RxDC submission.
- Include:
- Premium or premium equivalents paid by members for medical and pharmacy coverage.
- Advance premium tax credits (APTCs) in the individual and fully insured small group markets.
- Member payments for COBRA coverage, including the 2% administrative fee.
- Spousal and tobacco surcharges.
- Exclude: Premium or premium equivalents paid by employers or other plan sponsors on behalf of members.
- Premium Equivalents Definition
- For self-funded plans and other arrangements that do not rely exclusively or primarily on premiums, report the premium equivalent amounts representing the total cost of providing and maintaining coverage, including claims costs, administrative costs, Administrative Services Only (ASO) and other TPA fees, and stop-loss premiums. Please subtract stop-loss reimbursement amounts from total premium amount. An employer with a self-funded plan may use, as the total cost of providing and maintaining coverage, the same costs that are considered for purposes of calculating COBRA premiums (minus the 2% administration charge, if applicable).
- Additional Information
- The information you provide will be pooled together into an aggregated report for each funding type (insured versus self-funded) for either Kansas or Missouri, depending on the state your contract was issued (insured groups) or where your plan has its principal place of business (self-funded) and then placed into either the small group category or large group category (51+ employees).
- Your information will not be identifiable in the final report since it will be combined with other plans’ information in your applicable line of business, but we will report that you responded to the requirement. Additionally, Blue KC will not analyze the data for internal purposes.
- Visit https://go.cms.gov/3VJMmoq for additional information about this annual report.
