Data Request and Attestation for PDP Sponsors (CMS-10691)

42 CFR 423.513(g)(1)(i) states that beginning in plan year 2020, a PDP sponsor may submit a request to CMS for the data described in paragraph (g)(2) about enrollees in its prescription drug plans. In addition, paragraph (g)(5) provides that as a condition of receiving the requested data, the PDP sponsor must attest that it will adhere to the permitted uses and limitations on the use of the Medicare claims data listed in paragraphs (g)(3) and (4).

The latest form for Data Request and Attestation for PDP Sponsors (CMS-10691) expires 2022-11-30 and can be found here.