Retiree Drug Subsidy Payment Request Instructions (CMS-10170)

OMB 0938-0977

OMB 0938-0977

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and implementing regulations at 42 CFR ?423 Subpart R, Plan Sponsors (e.g., employers or unions) that offer prescription drug coverage to their qualifying covered retirees are eligible to receive a 28% tax-free subsidy for allowable drug costs. In order to receive the subsidy, a Plan Sponsor must submit required prescription drug cost data and certain other data to CMS.

The latest form for Retiree Drug Subsidy Payment Request Instructions (CMS-10170) expires 2020-06-30 and can be found here.

OMB Details

Private Sector -- Retiree Drug Subsidy (RDS) Payment Request and Instructions

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10170Retiree Drug Subsidy PaymentFillable PrintableForm

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