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pdfRx Setup – Page 1
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 22
Rx Setup – Page 2
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 22
Rx Setup – Page 3
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 22
Rx Setup – Page 4
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 22
Rx Cost Share – Page 1
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 22
Rx Cost Share – Page 2
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 22
Rx Cost Share – Page 3
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 22
Tier Locations – Page 1
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 22
Tier Locations – Page 2
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 22
Tier Locations – Page 3
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 22
Tier Locations – Page 4
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 22
CY 2025 PBP Data Entry System Screens
Tier Setup Screen (Sample for Tier 1 with Preferred Generic)
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 22
CY 2025 PBP Data Entry System Screens
Initial Coverage Phase Screen (Sample for Tier 1 with Preferred Generic) – Page 1
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 22
CY 2025 PBP Data Entry System Screens
Initial Coverage Phase Screen (Sample for Tier 1 with Preferred Generic) – Page 2
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 22
CY 2025 PBP Data Entry System Screens
Initial Coverage Phase Screen (Sample for Tier 1 with Preferred Generic) – Page 3
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 22
CY 2025 PBP Data Entry System Screens
Initial Coverage Phase Screen (Sample for Tier 1 with Preferred Generic) – Page 4
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 22
CY 2025 PBP Data Entry System Screens
Post OOP Screen (Sample for Tier 1 with Preferred Generic)
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 22
Medicare Rx Attestations
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 22
Rx Notes
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 22
Rx Insulin
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 22
CY 2025 PBP Data Entry System Screens
Rx Insulin Tier Screen (Sample for Tier 1 – Preferred Generic) – Page 1
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 22
CY 2025 PBP Data Entry System Screens
Rx Insulin Tier Screen (Sample for Tier 1 – Preferred Generic) – Page 2
Softrams
CY2025 PBP – Section Rx
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 22
| File Type | application/pdf |
| File Title | CY 2025 PBP Data Entry System Screens |
| Author | CMS |
| File Modified | 2023-12-06 |
| File Created | 2023-12-06 |