CMS-10110 Financial Data Template

---

Overview

Instructions
Financial Data Template

---

Sheet 1: Instructions

Overview Manufacturers have the option to use this template to upload product data into ASP. You will enter the financial data for upload on the "Financial Data Template" worksheet. Data can be uploaded during the 30-day submission period after the end of the quarter. It is recommended to upload this template no later than 5 days prior to the submission due date each quarter. There is a separate template to upload product data.
Requested Information For each NDC or Alternate ID, enter the following: column a. Manufacturer Name column b. NDC1 column c. NDC2 column d. NDC3 column e. Alternate ID column f. Manufacturer's Average Sales Price column g. Number of ASP Units column h. Wholesale Acquisition Cost column i. Average Wholesale Price Do not change the column names.
Column Guidelines
Column Name	Format	Allowed/Sample Values	Required/optional	Notes
Manufacturer Name	alphanumeric	maximum of 250 characters	Required	When entering product data for the same Manufacturer more than once, be sure the spelling matches. Special characters (comma, dash, period) allowed	Column A - 1) This is a required free form field
NDC1	5-digit number	e.g. 12345	Required	Not required if the product has an Alternate ID Leading zero allowed	Column B - 1) This is a requred field if Alternate ID is left blank 2) 5 digit number which identifies the labeler.
NDC2	4-digit number	e.g. 1234	Required	Not required if the product has an Alternate ID	Column C - 1) This is a requred field if Alternate ID is left blank 2) 4 digit number which identifies the product.
NDC3	2-digit number	e.g. 12	Required	Not required if the product has an Alternate ID	Column D - 1) This is a requred field if Alternate ID is left blank 2) 2 digit number which identifies the package size.
Alternate ID	alphanumeric	maximum of 23 characters	Required	Not required if the product has an NDC. Must match product ID exactly as listed publicly. Special characters (colon, dash, period) allowed	Column E - 1) This is a required field if NDC1, NDC2, or NDC3 is left blank. 2) Numeric or alphanumeric alternate drug identifier (ex. An NHRIC number) can be entered. 3) Value must be 23 characters or less.
Manufacturer's Average Sales Price	numeric	maximum of 10 digits and 3 decimal places	Required	Must have three decimal places (XXXXXXXXXX.XXX). Can be positive, negative, or 0.000 A manufacturer average sales price for each National Drug Code assigned to the drug or biological product.	Column F - 1) This is a required field 2) Value must be any positive or negative numbers including zero 3) Value must include three decimal places. 4) ASP should not be greater than WAC but ASP could be greater than WAC 5) "$" is not an allowed value. Note: The CMS validation macro will flag an NDC if the ASP is greater than WAC .
Number of ASP Units	numeric	maximum of 10 digits and 3 decimal places	Required	Must have three decimal places (XXXXXXXXXX.XXX). Can be positive, negative, or 0.000 Units = the product represented by the NDC, unless otherwise specified by CMS to account for situations where labeling indicates that the amount of drug product represented by a National Drug Code varies.	Column G - 1) This is a required field 2) Must show three decimal places 3) Must be any valid positive or negative number including zero.
Wholesale Acquisition Cost	numeric	maximum of 10 digits and 3 decimal places	Required	Must have three decimal places (XXXXXXXXXX.XXX). Must be positive The manufacturer's list price for the drug or biological to wholesalers or direct purchasers as reported in wholesale price guides or other publications of drug or biological pricing data. For more on the definition of WAC, see 42 U.S.C. 1395w-3a.	Column H - 1) This is a required field 2) WAC must be a valid or positive number 3) Value must include three decimal places. 4) "$" is not an allowed value.
Average Wholesale Price	numeric	maximum of 10 digits and 3 decimal places	Optional	Must have three decimal places (XXXXXXXXXX.XXX). Must be positive The price for the drug or biological to retail pharmacies, physicians and other entities from the wholesaler and is reflected in published compendia.	Column I - 1) This is an optional field 2) AWP must be a valid or positive number 3) Value must include three decimal places. 4) "$" is not an allowed value.

---

Sheet 2: Financial Data Template

Manufacturer Name

NDC1

NDC2

NDC3

Alternate ID

Manufacturer's Average Sales Price

Number of ASP Units

Wholesale Acquisition Cost

Average Wholesale Price