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_PBP2025 VBID Rx

OMB: 0938-0763

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Rx VBID Setup Screen

Softrams

CY 2025 PBP Data Entry System Screens

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Part D Rewards and Incentives Packages Setup

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CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Rewards and Incentives – Add New Package – Page 1

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Rewards and Incentives – Add New Package – Page 2

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Rewards and Incentives – Add New Package – Page 3

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 16

VBID DS Reduced Cost Sharing – Page 1

Softrams

CY 2025 PBP Data Entry System Screens

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 16

VBID DS Reduced Cost Sharing – Page 2

Softrams

CY 2025 PBP Data Entry System Screens

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 16

VBID DS Reduced Cost Sharing – Page 3

Softrams

CY 2025 PBP Data Entry System Screens

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing Packages Setup (AE, BA, and EA Benefit Types)

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing Package – Add New Package – Page 1

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing Package – Add New Package – Page 2

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing Package – Add New Package – Page 3

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing – Initial Coverage Phase Tier Screen – Page 1

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing – Initial Coverage Phase Tier Screen – Page 2

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing – Initial Coverage Phase Tier Screen – Page 3

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 16

CY 2025 PBP Data Entry System Screens

Rx VBID Reduction in Cost Sharing – Initial Coverage Phase Tier Screen – Page 4

Softrams

CY2025 PBP – Rx VBID
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 16


File Typeapplication/pdf
File TitlePBP 2025 VBID RX
AuthorCMS
File Modified2023-12-18
File Created2023-12-18

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