CMS-R-262 VBID – General

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Appendix_C_PBP2023_Screenshots_Section_Rx_VBID

CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

Document [pdf]
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VBID – General

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID Part D Rewards and Incentives #1

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
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VBID Part D Rewards and Incentives #2

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
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VBID Part D Rewards and Incentives #3

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
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VBID – DS Reduced Cost Sharing – Base 1

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
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VBID – DS Reduced Cost Sharing – Base 2

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Package Setup

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Package Tiers – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Tier Coverage – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Tier Locations – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Retail Copayment – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Retail Coinsurance – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Mail Order Copayment – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Mail Order Coinsurance – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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CY 2023 PBP Data Entry System Screens

VBID – Out-of-Network and LTC Cost Sharing – Pre-ICL

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CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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CY 2023 PBP Data Entry System Screens

VBID – Daily Retail and Mail Order Copay – Pre-ICL

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CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Daily LTC Copay – Pre-ICL

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Package Tiers – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Tier Coverage – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Tier Locations – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Retail Copayment – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Retail Coinsurance – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Mail Order Copayment – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Mail Order Coinsurance – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 31

CY 2023 PBP Data Entry System Screens

VBID – Out-of-Network and LTC Cost Sharing – Gap

Softrams

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 31

CY 2023 PBP Data Entry System Screens

VBID – Daily Retail and Mail Order Copay – Gap

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CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Daily LTC Copay – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Daily LTC Copay – Gap

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Tier Coverage – OOP Threshold

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Post OOP Threshold Cost Sharing

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID – Package notes

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section Rx VBID
09/13/2021
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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File Typeapplication/pdf
File TitleCY 2023 PBP Data Entry System Screens
AuthorCMS
File Modified2021-09-08
File Created2021-09-07

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