CY2022 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

CY 2021 LIS Cost Sharing Reduction 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

NUMBER
RxCUI

Always Required

Maximum
of 8 digits

Cost Sharing

Always Required

Field Description

Sample
Field Value(s)

RxCUI concept unique identifier.

210597

Cost sharing amount

1.00

NUMBER
3 digits

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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