Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 NADAC Survey Tool	Form and Instruction	New	Available
Form CMS-10241 Annual State Report and Annual State Performance Ranking	Form and Instruction	Modified	Available
CLEAN Comments Responses RPS PRA FR 30-day Posting 5-2-12.docx	Supplementary Document	Uploaded 2012-05-07	Available
Revised RPS PRA Supporting Statement B.doc	Supporting Statement B	Uploaded 2012-03-02	Available
Response to Public Comments.docx	Supplementary Document	Uploaded 2012-03-02	Available
Crosswalk RPS PRA.doc	Supplementary Document	Uploaded 2012-03-02	Available
Supporting Statement.doc	Supporting Statement A	Uploaded 2012-05-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201423	Survey of Retail Community Pharmacy Invoice Prices	Form and Instruction	New	NADAC Survey Tool
201423	Survey of Retail Community Pharmacy Invoice Prices	Instruction	New
183391	Annual State Report and Annual State Performance Rankings (CMS-10241)	Form and Instruction	Modified	Annual State Report and Annual State Performance Ranking

ICR Details

OMB Control No: 0938-1041	ICR Reference No: 201203-0938-002
Status: Historical Active	Previous ICR Reference No: 201103-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/11/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/05/2012
Terms of Clearance: Prior to renewal or revision of the NADAC survey, CMS must provide OMB with information on the quality of data obtained through this survey and any problems with pharmacy non-response.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved	05/31/2014
Responses	30,051	0	51
Time Burden (Hours)	15,765	0	765
Cost Burden (Dollars)	0	0	0

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Abstract: This revision request is for a survey of the average acquisition costs of all covered outpatient drugs purchased by retail community pharmacies. The prices will be updated on at least a monthly basis.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 6001 Name of Law: Deficit Reduction Act
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 171 6001(f) Name of Law: Deficit Reduction Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60845	09/30/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 12847	03/02/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Annual State Report and Annual State Performance Rankings (CMS-10241)	CMS-10241	Annual State Report and Annual State Performance Ranking
Survey of Retail Community Pharmacy Invoice Prices	1	NADAC Survey Tool

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30,051	51	30,000	0	0	0
Annual Time Burden (Hours)	15,765	765	15,000	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This package is being revised to include a second survey tool to survey the pharmacies. This second survey is entitled "Survey of Retail Community Pharmacy Invoice Prices." CMS will also develop a National Average Drug Acquisition Cost (NADAC) for States to consider when developing reimbursement methodology. The NADAC is a new pricing benchmark that will be based on the national average costs that pharmacies pay to acquire Medicaid covered outpatient drugs. This pricing benchmark will be based on drug acquisition costs collected directly from pharmacies through a nationwide survey process. This survey will be conducted on a monthly basis to ensure that the NADAC reference file remains current and up-to-date.

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Annual Cost to Federal Government: $6,200,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/05/2012

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