Consolidated Appropriations Act – Required Rx DC Reporting

As a Health Plan Group Administrator, you likely have received an email communication from your medical insurance company. This is a request for a small amount of information that will allow the carrier to submit much more detailed Prescription Drug utilization numbers to the government on your behalf.

To the extent we can view the forms (we can only see Anthem’s) the requested information seems quite basic. The only information requiring much thought involves the percentage of premium paid by the employee and employer. This would generally be found by looking at your accounting software and in some cases payroll withholding.  We recommend a good faith effort to get as close to the correct percentage as possible, but there is likely some leeway.

Below is what we have heard from the various carriers:

Anthem Blue Cross

Anthem Link -  data submission form

Other than basic group information they ask:

1.)   Average Monthly Percentage of Premium Covered by Employee

2.)   Average Monthly Percentage of Premium Covered by the Employer / Group

3.)   Form 5500 # - Generally companies don’t file this if they have fewer than 100 Employees

Blue Shield  (likely request similar information to Anthem)

• Active groups will need to fill out the intake form available on Employer Connection upon logging in.

• Terminated groups will need to fill out this intake form, using their Blue Shield group ID and following web key: #24yr23.

Health Net

Health Net sent an email saying there is no employer requirement for filing this. Health Net will submit everything on the employer’s behalf.

Kaiser

They are in the process of revising their form and will contact employers directly soon. Their requirements should be like Anthem’s.