CMS-R-262 VBID Rx

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

Appendix_C_PBP2024 VBID Rx

OMB: 0938-0763

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:
2024-01-25 - Revision of a currently approved collection
Document [pdf]
Download: pdf | pdf
VBID Rx Setup Screen

Softrams

CY 2023 PBP Data Entry System Screens

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Rewards and Incentives Packages

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CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Rewards and Incentives – Add New Package – Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Rewards and Incentives – Add New Package – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Rewards and Incentives – Add New Package – Page 3

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduced Cost Sharing (DS Benefit types)– Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduced Cost Sharing (DS Benefit types) – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduced Cost Sharing (DS Benefit types) – Locations and Location Supply – Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduced Cost Sharing (DS Benefit types)– Locations and Location Supply – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing Packages (non-DS Benefit types)

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Add New Package – Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Add New Package – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Add New Package – Page 3

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Add New Package – Page 4

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Pre-ICL Tier Screen – Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Pre-ICL Tier Screen – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Pre-ICL Tier Screen – Page 3

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Coverage GAP Tier Screen – Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Coverage GAP Tier Screen – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Coverage GAP Tier Screen – Page 3

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Coverage GAP Tier Screen – Page 4

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Post OOP Tier Screen – Page 1

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Post OOP Tier Screen – Page 2

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Post OOP Tier Screen – Page 3

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 25

CY 2023 PBP Data Entry System Screens

VBID Part D Reduction in Cost Sharing – Post OOP Tier Screen – Page 4

Softrams

CY2024 PBP – Rx VBID
01/13/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 25
File Type	application/pdf
File Title	PBP 2024 VBID Rx
Author	CMS
File Modified	2023-01-12
File Created	2022-09-13