CMS Form-367e_Quarterly VBP-MBP_09.2021_Final

MEDICAID DRUG REBATE PROGRAM

MDP QUARTERLY VBP-MBP FILE FORMAT
FILE SUBMISSION TO CMS
Form CMS-367e
FILE FORMAT
Effective: July 1, 2022

Source: Drug Manufacturers
Target: CMS
Ordinal Field Name (.TXT)
Position Header Row (.CSV)

Size

Position

Remarks

1

Labeler Code

5

1-5

NDC 1

2

Product Code

4

6 - 10

NDC 2

3

FDA Product Name

63

11 - 74

FDA Product Name

4

Arrangement Identifier

3

75 - 78

See Data Definitions

5

Tier

3

79 - 82

See Data Definitions

6

VBP GNUP

15

83 - 98

99999999.999999

Form CMS-367e (Exp. TBD) 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.

MEDICAID DRUG REBATE PROGRAM

MDP QUARTERLY VBP-MBP FILE FORMAT
FILE SUBMISSION TO CMS
Form CMS-367e
DATA DEFINITIONS
Effective: July 1, 2022

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; right-justified;
zero-padded.
FDA Product Name: Drug name as it appears on FDA SPL listing. Alpha-numeric values; 63character field; left-justified; blank-filled for FDA Product Names fewer than 63 characters.
Arrangement Identifier: The number assigned to each VBP arrangement offered for an NDC
Numeric values; 2-digit field; right-justified; zero-padded.
Valid Values: 01-99
Tier: The number assigned to each outcome-based tier within a given arrangement. Numeric values;
3-digit field; right-justified; zero-padded.
Valid Values: 001-999
Value-Based Purchasing (VBP) Guaranteed Net Unit Price (GNUP): The Value-Based Purchasing
Guaranteed Net Unit Price associated with each tier. This is the VBP best price available to the state if
they enter into a VBP arrangement with a labeler. The VBP GNUP can vary depending on the terms of
the arrangement. Numeric value; 15-digit field (8 whole numbers, a decimal point, and 6 decimals)

Form CMS-367e (Exp. TBD) 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.