CMS-367b Monthly Pricing Data

DDR MONTHLY PRICING DATA FILE FORMAT
FOR TEXT FILE SUBMISSIONS TO CMS

Source: Drug Manufacturers
Target: CMS
Field

Size

Position

Remarks

Record ID

1

1–1

Constant of “M”

Labeler Code

5

2–6

NDC 1

Product Code

4

7 – 10

NDC 2

Package Size

2

11 – 12

NDC 3

Month

2

13 – 14

MM

Year

4

15 – 18

YYYY

Average Manufacturer Price (AMP)

12

19 – 30

99999.999999

AMP Units

14

31 – 44

99999999999.99

5i Threshold

1

45 - 45

Y, N, X, or Z

Form CMS-367b (Exp. ) is used by manufacturers on a monthly basis, to transmit pricing data for each of their covered outpatient drugs to CMS
either electronically or via file transfer. The use of Form CMS-367b on a monthly basis by manufacturers is considered mandatory under the
authority of Section 1927 of the Social Security Act and the National Drug Rebate Agreement. Under the Privacy Act of 1974 any personally
identifying information obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938-0578. The time required to complete this
information collection is estimated to average 44.8 hours per response, including the time to review instructions, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate or suggestions for
improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.

DDR MONTHLY PRICING DATA FILE FORMAT
FOR TEXT FILE SUBMISSIONS TO CMS
Monthly Pricing (CMS 367b Form) Data Element Definitions
Record ID: Constant of “M”. The M Record ID indicates that the information reported for this
NDC represents monthly pricing data.
Labeler Code: First segment of the National Drug Code (NDC) that identifies the labeler.
Numeric values; 5-digit field; right-justified; zero-padded.
Product Code: Second segment of the NDC. Alpha-numeric values; 4-digit field; rightjustified; zero-padded.
Package Size: Third segment of the NDC. Alpha-numeric values; 2-digit field; right-justified;
zero-padded.
Month: Calendar month covered by the pricing data submission. Numeric values; 2-digit field;
format: MM.
Valid values for MM:
01 = January
02 = February
03 = March
04 = April
05 = May
06 = June
07 = July
08 = August
09 = September
10 = October
11 = November
12 = December
Year: Calendar year covered by the pricing data submission. Numeric values; 4-digit field;
format: YYYY.
Valid values for YYYY: 4-digit calendar year equal to 2007 or later.

Form CMS-367b (Exp. ) is used by manufacturers on a monthly basis, to transmit pricing data for each of their covered outpatient drugs to CMS
either electronically or via file transfer. The use of Form CMS-367b on a monthly basis by manufacturers is considered mandatory under the
authority of Section 1927 of the Social Security Act and the National Drug Rebate Agreement. Under the Privacy Act of 1974 any personally
identifying information obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938-0578. The time required to complete this
information collection is estimated to average 44.8 hours per response, including the time to review instructions, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate or suggestions for
improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.

DDR MONTHLY PRICING DATA FILE FORMAT
FOR TEXT FILE SUBMISSIONS TO CMS
Average Manufacturer Price (AMP): The AMP per unit per product code for the month/year
covered, based on sales. If a drug is distributed in multiple package sizes, there will be one
“weighted” AMP for the product, which is the same for all package sizes. Compute to 7
decimal places and round to 6 decimal places. Numeric values; 12-digit field: 5 whole numbers,
the decimal point (‘.’) and 6 decimal places; right-justified; zero-padded for AMP values with
fewer than 12 digits.
AMP Units: The total sum of all units included in the calculation of the AMP per product code
for the monthly reporting period. If a drug is distributed in multiple package sizes, there will be
one AMP unit value for the product, which is the same for all package sizes. Numeric values; 14digit field: 11 whole numbers, the decimal point (“.”) and 2decimal places; right-justified; zeropadded.
5i Threshold: A value indicating whether the reported AMP was calculated using the alternate
5i AMP methodology (i.e., a 5i Threshold value of “Y”), or using the standard (non-5i)
methodology (i.e., a 5i Threshold value of “N”). A 5i Threshold value of “X” should be reported
if the NDC was not classified as a 5i drug for the month/year combination being reported. For
months prior to July 2014 (i.e., the month in which the 5i Threshold field was implemented), a
5i Threshold value of “Z” should be reported to indicate the field was not applicable. 1character field.
Valid Values:
Y = Yes
N = No
X = Not a 5i drug
Z = Not Applicable

Form CMS-367b (Exp. ) is used by manufacturers on a monthly basis, to transmit pricing data for each of their covered outpatient drugs to CMS
either electronically or via file transfer. The use of Form CMS-367b on a monthly basis by manufacturers is considered mandatory under the
authority of Section 1927 of the Social Security Act and the National Drug Rebate Agreement. Under the Privacy Act of 1974 any personally
identifying information obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938-0578. The time required to complete this
information collection is estimated to average 44.8 hours per response, including the time to review instructions, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate or suggestions for
improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.