[Medicaid] Survey of Retail Prices (CMS-10241)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10241 Survey of Retail Prices (Spanish)	Form and Instruction	Modified	Available
Form CMS-10241 Survey of Retail Prices (English)	Form and Instruction	Modified	Available
Form CMS-10241 Survey of Retail Prices	Form and Instruction	Modified	Repair queued
CMS-10241 - Justification for Nonsubstantive Changes (2025 version 4).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-12-10	Available
CMS-10241 - Justification for Nonsubstantive Changes (2025 version 4).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-12-10	Repair queued
CMS-10241 - Supporting Statement B - (2025 version 3)_508.docx	Supporting Statement B	Uploaded 2025-12-10	Available
CMS-10241 - Supporting Statement B - (2025 version 3)_508.docx	Supporting Statement B	Uploaded 2025-12-10	Repair queued
CMS-10241 - Supporting Statement A (2025 version 3)_508.docx	Supporting Statement A	Uploaded 2025-12-10	Repair queued
CMS-10241 - Supporting Statement A (2025 version 3)_508.docx	Supporting Statement A	Uploaded 2025-12-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201423	Survey of Retail Prices	Form and Instruction	Modified	Survey of Retail Prices (Spanish)
201423	Survey of Retail Prices	Form and Instruction	Modified	Survey of Retail Prices (English)
201423	Survey of Retail Prices	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1041	ICR Reference No: 202512-0938-013
Status: Active	Previous ICR Reference No: 202310-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Survey of Retail Prices (CMS-10241)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/15/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/11/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	12/31/2026	12/31/2026
Responses	72,000	0	72,000
Time Burden (Hours)	36,000	0	36,000
Cost Burden (Dollars)	0	0	0

---

Abstract: CMS is performing a "Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings." This study is divided into two parts. Part I focuses on the retail community pharmacy consumer prices. It also includes reporting by the States of payment and utilization rates for the 50 most widely prescribed drugs, and comparing State drug payment rates with the national retail survey prices. The template for States to use to complete (Effective July 1, 2013, CMS has suspended Part I of the nationwide retail survey for collecting information about consumer purchase prices, pending funding decisions.) Part II of this contract focuses on the retail community pharmacy ingredient costs. This segment provides for a survey of the average acquisition costs of all covered outpatient drugs purchased by retail community pharmacies. The prices will be updated on at least a monthly basis.

---

Authorizing Statute(s): PL: Pub.L. 109 - 171 6001 Name of Law: Deficit Reduction Act
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 171 6001(f) Name of Law: Deficit Reduction Act

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 50157	08/01/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 71367	10/16/2023
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Survey of Retail Prices	CMS-10241, CMS-10241	Survey of Retail Prices (English) ,   Survey of Retail Prices (Spanish)

---

ICR Summary of Burden

table that charts list 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	72,000	72,000	0	0	0	0
Annual Time Burden (Hours)	36,000	36,000	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $3,518,671

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? No

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

---

Common Form ICR:  No

---

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: 12/11/2025

---