CY2021 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

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). In
addition, drugs from fully
covered tiers or tiers without
additional gap coverage must
not be submitted on the Partial
Gap Coverage file.

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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