CMS Plan Benefit Package (PBP) and Formulary CY 2026 (CMS-R-262) - IRA

Forms and Documents

Document	Type	Status	Availability
Form CMS-R-262 Benefit Details - Service Categories 16-20	Form and Instruction	Modified	Available
Form CMS-R-262 CY 2026 Prior Authorization File Record Layout	Form and Instruction	Modified	Available
Form CMS-R-262 VBID-UF-SSBCI Packages	Form and Instruction	Modified	Available
Form CMS-R-262 VBID Rx	Form and Instruction	Modified	Available
Form CMS-R-262 Section Rx	Form and Instruction	Modified	Available
Form CMS-R-262 General Setup	Form and Instruction	Modified	Available
Form CMS-R-262 Cost Share Groups	Form and Instruction	Modified	Available
Form CMS-R-262 Benefit Details-Service Categories 11-15	Form and Instruction	Modified	Available
Form CMS-R-262 Benefit Details-Service Categories 1-10	Form and Instruction	Modified	Available
Form CMS-R-262 MTM2026 Mockup	Form and Instruction	Modified	Available
Form CMS-R-262 CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	Repair queued
CY2026 - PBP 30-day comments 05092025_draft.docx	Supplementary Document	Uploaded 2025-05-12	Repair queued
UHC Comments_CY2026 PBP Formulary Comment Letter_4.21.2025.pdf	Public Comments	Uploaded 2025-04-21	Repair queued
Appendix_A_CMS-R-262_CY2026_PBP_Sprtng_Stmnt_.docx	Supporting Statement A	Uploaded 2025-05-12	Repair queued
Appendix_A_CMS-R-262_CY2026_PBP_Sprtng_Stmnt_clean.docx	Supporting Statement A	Uploaded 2025-03-21	Repair queued
UnitedHealthcare.pdf	Public Comments	Uploaded 2025-01-06	Repair queued
Humana.pdf	Public Comments	Uploaded 2025-01-06	Repair queued
Healthpartners.pdf	Public Comments	Uploaded 2025-01-07	Repair queued
Appendix_B_PRA List of changes CY 2026 30 day clean.pdf	Supplementary Document	Uploaded 2025-03-18	Repair queued
Appendix_B_PRA List of changes CY 2026 30 day clean.pdf	Supplementary Document	Uploaded 2025-03-18	Repair queued
Appendix_B_PRA_List_of_changes_CY_2026.pdf	Supplementary Document	Uploaded 2025-03-18	Repair queued
Appendix_B_PRA_List_of_changes_CY_2026.pdf	Supplementary Document	Uploaded 2025-03-18	Missing upstream
CY2026 PRA 60-day comments.docx	Supplementary Document	Uploaded 2025-03-18	Repair queued
CY2026 PRA 60-day comments.docx	Supplementary Document	Uploaded 2025-03-18	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	Benefit Details - Service Categories 16-20
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	CY 2026 Prior Authorization File Record Layout
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	VBID-UF-SSBCI Packages
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	VBID Rx
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	Section Rx
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	General Setup
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	Cost Share Groups
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	Benefit Details-Service Categories 11-15
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	Benefit Details-Service Categories 1-10
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified	MTM2026 Mockup
43667	CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0763	ICR Reference No: 202503-0938-003
Status: Active	Previous ICR Reference No: 202401-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: CMS Plan Benefit Package (PBP) and Formulary CY 2026 (CMS-R-262) - IRA
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/10/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2027	36 Months From Approved	03/31/2027
Responses	8,337	0	8,770
Time Burden (Hours)	46,026	0	55,782
Cost Burden (Dollars)	0	0	0

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Abstract: CMS has incorporated the following changes to address the Inflation Reduction Act (IRA). This includes new attestations and data entry fields to reflect Part D policy changes (i.e., new insulin and vaccine benefits and $0 cost sharing in the catastrophic phase) that are required by the IRA, specifically Sections 11101, 11201, 11401, and 11406. CMS is also modernizing the PBP software by migrating from its current client/server based platform to a new web-based module within HPMS. This initiative is critical, as the current platform technically antiquated. The new PBP module will enhance system security, improve the user interface, streamline the bid submission process, increase system performance, and provide greater flexibility to accommodate unique benefit designs. CMS requires that MA and PDP organizations submit a completed formulary and PBP as part of the annual bidding process. During this process, organizations prepare their proposed plan benefit packages for the upcoming contract year and submit them to CMS for review and approval.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Prescription Drug, Improvement, and Modernization Act of2003 (MMA)
   PL: Pub.L. 117 - 169 11101,11201, 11401, and 11406 Name of Law: Inflation Reduction Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 88052	11/06/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 13368	03/21/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
CY2026 Plan Benefit Package (PBP) Software and Formulary Submission	CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262	MTM2026 Mockup ,   Benefit Details-Service Categories 1-10 ,   Benefit Details-Service Categories 11-15 ,   Cost Share Groups ,   General Setup ,   Section Rx ,   VBID Rx ,   VBID-UF-SSBCI Packages ,   CY 2026 Prior Authorization File Record Layout ,   Benefit Details - Service Categories 16-20

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	8,337	8,770	0	-433	0	0
Annual Time Burden (Hours)	46,026	55,782	0	-9,756	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease to burden is attributable to a decrease in the number of reporting organizations from 825 to 785, as well as a decrease in the number of formulary submissions from 519 to 484 and estimated reduction in burden hours for completing the formulary submissions.

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Annual Cost to Federal Government: $2,258,092

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/28/2025

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