CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Appendix_C_CY2015 Plan Gap Coverage File Layout

CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

OMB: 0938-0763

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CY 2015 Gap Coverage File Record Layout
Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”
Field Name

Field Type

Maximum
Field
Length

Field Description

Sample
Field Value(s)

RxCUI concept unique identifier
from the active Formulary
Reference File.

NUMBER
RxCUI

Always Required

Maximum
of 8 digits

Note: Partial Gap Coverage file
must not include ALL the drugs
from the partial gap tier(s).

210597

Please Note: Certain characters are restricted from HPMS. The submitted file will be rejected if any of the
following characters are included in any field: 1) greater than sign (>), 2) less than sign (<), and 3) semicolon (;).

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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File Typeapplication/pdf
File TitleCY 2012 Gap Coverage File Record Layout
AuthorCMS
File Modified2013-09-11
File Created2013-09-11

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