Medicare Transaction Facilitator for 2026 and 2027 under Sections 11001 and 11002 of the Inflation Reduction Act (IRA) (CMS-10912)

ICR 202503-0938-001

OMB:

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10912 Non-MTF User to Complete Drug Price Negotiation Program MTF DM Complaint Intake Form Form and Instruction	New
Form CMS-10912 Primary Manufacturer and/or Dispensing Entity to Complete Drug Price Negotiation Program Complaint and Dispute Intake Form Form and Instruction	New
Form CMS-10912 Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Payment Elements Form Form and Instruction	New
Form CMS-10912 Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Primary Manufacturer MFP Effectuation Plan Form Form and Instruction	New
Form CMS-10919 Dispensing Entity to Complete Drug Price Negotiation Program MTF DM Dispensing Entity and Third-Party Support Entity Enrollment Form Form and Instruction	New
CMS-10912.Supporting Statement Part A .docx Supporting Statement A	2025-04-01
2025.03.10_IPAY 2026-27 60 to 30-day MTF ICR_Crosswalk_clean.docx Supplementary Document	2025-03-20
2025.03.10_MTFICR_CommentResponseSummary_clean.docx Supplementary Document	2025-03-20

IC Document Collections

IC ID	Document Title	Status
274493	Non-MTF User to Complete Drug Price Negotiation Program MTF DM Complaint Intake Form Form and Instruction	New
274428	Primary Manufacturer and/or Dispensing Entity to Complete Drug Price Negotiation Program Complaint and Dispute Intake Form Form and Instruction	New
274427	Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Payment Elements Form Form and Instruction	New
274426	Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Primary Manufacturer MFP Effectuation Plan Form Form and Instruction	New
274425	Dispensing Entity to Complete Drug Price Negotiation Program MTF DM Dispensing Entity and Third-Party Support Entity Enrollment Form Form and Instruction	New