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.
Document Name |
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Supporting Statement A |
Supplementary Document |
Supplementary Document |
Revision of a currently approved collection | 2024-09-23 | ||
Reinstatement without change of a previously approved collection | 2020-08-17 | ||
Approved with change |
Extension without change of a currently approved collection | 2017-02-23 | |
Approved without change |
Reinstatement without change of a previously approved collection | 2013-11-22 | |
Approved without change |
Revision of a currently approved collection | 2009-04-02 | |
Approved without change |
Extension without change of a currently approved collection | 2006-03-09 | |
Approved with change |
New collection (Request for a new OMB Control Number) | 2005-10-06 |
Federal Enterprise Architecture: Health - Health Care Services
Form CMS-10170 | Retiree Drug Subsidy Payment | Fillable Printable | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.