CY2018 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

New for CY2017
Value Based Insurance Bid
CMS will collect a new supplemental file specific to the Value Based Insurance Bids. This file will
be collected via the existing supplemental file processes in the Formulary Submission Module.
This data will be collected at the formulary level. The draft file layout is included below.
Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”

Field Name

Contract ID

Field Type

Alphanumeric

Max. Field
Length

Field Description

Sample Value

5

Contract Number

H0001

3

Plan Number

001

8

RxCUI – must exist on the
related formulary file

210597

50

Identify the packages
defined in the PBP for the
RxCUI

1,3,7

Always Required
Plan ID

Number
Always Required

RxCUI

Number
Always Required

Packages

Alphanumeric
Always Required

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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Extended Day Supply
CMS will collect a new supplemenal file to capture drugs that are NOT covered with an
extended day supply. This file will be collected via the existing supplemental file processes in
the Formulary Submission Module. This data will be collected at the formulary level. The draft
file layout is included below.
Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”

Field Name

RxCUI

Field Type

Number
Always
Required

Max. Field Length

8

Field Description

RxCUI (unique identifier
from the active Formulary
Reference File.)

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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Sample Value

210597