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Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10142)
OMB: 0938-0944
IC ID: 37926
OMB.report
HHS/CMS
OMB 0938-0944
ICR 202412-0938-016
IC 37926
( )
Documents and Forms
Document Name
Document Type
Form CMS-10142
Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
Form
CMS-10142_Attachment_E-1_CY2026_MA_ BPT Instructions.docx
Instruction
CMS-10142_Attachment_E-2_CY2026_PD_BPT_Instructions.docx
Instruction
CMS-10142 Worksheets: Medicare Advantage Bid Pricing Tool
CMS-10142_Attachment_D-1_CY2026_MA_BPT.xlsx
Form
CMS-10142 Worksheets: Prescription Drug Bid Pricing Tool
CMS-10142_Attachment_D-2_CY2026_PD_BPT.xlsx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
Agency IC Tracking Number:
CM-CPC
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 422.250
42 CFR 422.254
42 CFR 423.322
42 CFR 422.266
42 CFR 423.279
42 CFR 423.286
42 CFR 423.293
42 CFR 422.264
42 CFR 422.252
42 CFR 422.256
42 CFR 422.258
42 CFR 422.262
42 CFR 422.306
42 CFR 423.301
42 CFR 422.310
42 CFR 423.329
42 CFR 422.318
42 CFR 422.316
42 CFR 422.320
42 CFR 422.322
42 CFR 423.258
42 CFR 422.314
42 CFR 423.265
42 CFR 423.272
42 CFR 422.270
42 CFR 423.336
42 CFR 423.315
42 CFR 423.343
42 CFR 422.300
42 CFR 422.312
42 CFR 423.308
42 CFR 422.308
42 CFR 423.350
42 CFR 422.304
42 CFR 422.324
42 CFR 423.346
42 CFR 423.251
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10142
Worksheets: Medicare Advantage Bid Pricing Tool
CMS-10142_Attachment_D-1_CY2026_MA_BPT.xlsx
Yes
Yes
Fillable Printable
Form
CMS-10142
Worksheets: Prescription Drug Bid Pricing Tool
CMS-10142_Attachment_D-2_CY2026_PD_BPT.xlsx
Yes
Yes
Fillable Printable
Instruction
CMS-10142_Attachment_E-1_CY2026_MA_ BPT Instructions.docx
Yes
No
Printable Only
Instruction
CMS-10142_Attachment_E-2_CY2026_PD_BPT_Instructions.docx
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
460
Number of Respondents for Small Entity:
25
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
11,700
0
0
6,705
0
4,995
Annual IC Time Burden (Hours)
406,000
0
0
256,150
0
149,850
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.