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

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

OMB: 0938-0763

IC ID: 43667

Documents and Forms

Document Name Document Type
Form CMS-R-262 CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262) Form and Instruction
CMS-R-262 MTM2025 Mockup Appendix_C_MTM2025 Mockups_508.pdf Form and Instruction
CMS-R-262 Benefit Details-Service Categories 1-10 Appendix_C_PBP2025 Benefit Details - Service Categories 1-10.pdf Form and Instruction
CMS-R-262 Benefit Details-Service Categories 11-20 Appendix_C_PBP2025 Benefit Details - Service Categories 11-20.pdf Form and Instruction
CMS-R-262 Cost Share Groups Appendix_C_PBP2025 Cost Share Groups.pdf Form and Instruction
CMS-R-262 General Setup Appendix_C_PBP2025 General Setup.pdf Form and Instruction
CMS-R-262 Section Rx Appendix_C_PBP2025 Section Rx.pdf Form and Instruction
CMS-R-262 VBID Rx Appendix_C_PBP2025 VBID Rx.pdf Form and Instruction
CMS-R-262 VBID-UF-SSBCI Packages Appendix_C_PBP2025 VBID-UF-SSBCI Packages.pdf Form and Instruction