CMS-R-262_CY2020_PBP_Sprtng_Stmnt_12_19_2020

Appendix A: Supporting Statement for Paperwork Reduction Act Submissions
CMS Plan Benefit Package (PBP) and Formulary CY 2020
CMS-R-262, OMB 0938-0763
The Plan Benefit Package (PBP), Formulary, and Supporting Regulations Contained in 42 Code
of Federal Regulation (CFR): 422.100, 422.101, 422.102, 422.103, 422.105, 422.106, 422.108,
422.110, 422.111, 422.112, 422.113, 422.114, 422.250, 422.252, 422.254, 422.256, 422.258,
422.262, 422.264, 422.266, 422.270, 422.300, 422.304, 422.306, 422.308, 422.310, 422.312,
422.314, 422.316, 422.318, 422.320, 422.322, 422.324, 423.100, 423.104, 423.112, 423.120,
423.124, 423.128, 423.132, 423.136, 423.251, 423.258, 423.265, 423.272, 423.286, 423.293,
423.301, 423.308, 423.315, 423.322, 423.329, 423.336, 423.343, 423.346, 423.350.
Background
Under the Medicare Modernization Act (MMA), Medicare Advantage (MA) and Prescription
Drug Plan (PDP) organizations are required to submit plan benefit packages for all Medicare
beneficiaries residing in their service area. The plan benefit package submission consists of the
Plan Benefit Package (PBP) software, formulary file, and supporting documentation, as
necessary. MA and PDP organizations use the PBP software to describe their organization’s plan
benefit packages, including information on premiums, cost sharing, authorization rules, and
supplemental benefits. They also generate a formulary to describe their list of drugs, including
information on prior authorization, step therapy, tiering, and quantity limits. Additionally, CMS
uses the PBP and formulary data to review and approve the plan benefit packages proposed by
each MA and PDP organization.
After receiving OMB clearance in spring 2000, CMS implemented the PBP as part of the
Contract Year (CY) 2001 Adjusted Community Rate Proposal (ACRP) process. In addition,
information collected via the PBP and formulary has been used to support the marketing material
review process, the National Medicare Education Program, and other program oversight and
development activities. The PBP data is used by the MA and Part D organizations in their
marketing materials and by CMS to generate plan benefits data for display in the Medicare &
You handbook and on the www.medicare.gov website.
CMS is requesting to continue its use of the PBP software and formulary submission for the
collection of benefits and related information for CY 2019. CMS estimates that 532 MA
organizations and 38 PDP organizations will be required to submit the plan benefit package
information in CY 2020. This is an increase from prior years, where 481 MA organizations and
39 PDP organizations were required to submit. This increase in MA organizations has caused the
burden estimate to increase. Based on operational changes and policy clarifications to the
Medicare program and continued input and feedback by the industry, CMS has made the
necessary changes to the plan benefit package submission.
This is a revision of the 60-day PRA package for the 30-day review. Changes have been made
compared to the 60-day package and include additional changes to the PBP that are identified in
the List of Changes, a change to the Formulary Opioid Strategy layout, and the addition of three
Formulary uploads which will not change the burden of submission. All details of the changes to
the Formulary submissions are found in the List of Changes document as well as the provided
screenshots. There were no changes to the MTMP portion of this PRA.

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A. Justification
1. Need and Legal Basis
This information is mandated by the Social Security Act in order to collect plan bids that will
establish the Medicare Advantage (Part C) and Prescription Drug (Part D) plan benefit package
options to be offered to Medicare beneficiaries during the next annual open enrollment period.
The Part C bid deadline (the first Monday in June) is stated at Section 1854(a)(6)(A) of the
Social Security Act. The same deadline is applied to Part D bids by reference to the Part C
requirement at Section 1860D-11(b)(1) of the Act and is cited in the 42 CFR references listed
above. Copies of these references are provided in Appendix D.
2. Information Users
This information is used by both CMS and the public.
CMS requires that MA and PDP organizations submit a completed PBP and formulary 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.
CMS uses this data to review and approve the benefit packages that the plans will offer to
Medicare beneficiaries. This allows CMS to review the benefit packages in a consistent way
across all submitted bids during with incredibly tight timeframes. This data is also used to
populate data on Medicare Plan Finder, which allows beneficiaries to access and compare
Medicare Advantage and Prescription Drug plans.
The PBP is broken into five specific sections:
1.) Section A defines certain plan-specific data characteristics in the Plan Benefit Package
(PBP). Section A consists primarily of high-level plan information, including the
Contract Number, Plan ID, Plan Type, Plan Name, and Geographic Service Area of the
plan. In addition, Section A allows organizations to indicate if they are offering a bid that
mirrors fee-for-service cost sharing. Both MA and Part D plans must complete this
section.
2.) Section B collects in-network benefit information for MA plans. This includes cost
sharing, premium information, and if supplemental benefits are offered. Section B is
broken into the following sections:
a. Inpatient Hospital Services
b. Skilled Nursing Facility (SNF)
c. Cardiac and Pulmonary Rehabilitation Services
d. Emergency Care/Urgently Needed Services
e. Partial Hospitalization
f. Home Health Services
g. Health Care Professional Services
h. Outpatient Procedures, Tests, Labs & Radiology Services
i. Outpatient Services
j. Ambulance/Transportation Services
k. DME, Prosthetics and Medical & Diabetic Supplies
l. Dialysis Services
m. Other Supplemental Services
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n. Preventive and Other Defined Supplemental Services
o. Medicare Part B Prescription (Rx) Drugs
p. Dental
q. Eye Exams/Eyewear
r. Hearing Exams/Hearing Aids
s. VBID/MA Uniformity Flexibility
t. Prescription Drugs (ONLY for Cost Plans not offering Part D
3.) Section C collects out-of-network information, as well as information regarding the
visitor/travel benefits and Point-of-Service Benefits. Only MA plans complete this
section.
4.) Section D collects plan-level information. Only MA plans complete this section. This
includes:
a. Plan Deductible
b. Maximum Enrollee Out-of-Pocket Costs
c. Maximum Coverage for Supplemental Benefits
d. Balance Billing (PFFS only)
e. Medical Savings Account Information (for MSA plans only)
f. Medicaid Covered vs. Plan Covered Cost sharing (for MMPs only)
g. Optional Supplemental Benefit Packages.
5.) Section Rx contains all Part D information. All plans that offer Part D must complete
this section. This includes:
a. Medicare Rx Screens
b. Pre-Initial Coverage Limit (ICL) Screens
c. ICL Screens
d. Gap Coverage Screens
e. Out-of-Pocket Threshold Screens
f. Locations and location supply Screens
g. Rx attestations
h. Medicare Rx Notes
i. Section Rx VBID (only for plans offering VBID)
The formulary submission contains the following files:
1.) Formulary Submission File (required for all Part D plans offering a formulary. This file
lists all Part D covered drugs offered by the plan)
2.) Formulary Over-the-Counter (OTC) Drugs File (required for any plans offering OTC
drugs as part of their Part D plan)
3.) Formulary Prior Authorization (PA) File (required for any Part D plans requiring PA for
any drugs on their formulary)
4.) Formulary Partial Gap Coverage File (required if there is partial tier gap coverage for the
Part D plan)
5.) Formulary Free First Fill File (required if any drugs are offered for free for their first fill)
6.) Formulary Excluded Drug File (required if the Part D plan offers excluded drugs)
7.) Formulary Additional Demonstration Drug File (only required for MMP plans)
8.) Formulary Opioid Strategy Submission and Layout (required for all Part D plans)
Exact layouts of the formulary files and detailed PBP data collect can be found within the
Appendix C documents.
CMS publishes beneficiary education information using a variety of formats. The specific
education initiatives that utilize PBP and formulary data include web application tools on
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www.medicare.gov and the plan benefit insert in the Medicare & You handbook. All other
information collected through the PBP follows the rules described in Section 10: Confidentiality.
3. Improved Information Technology
Since CY 2001, the Health Plan Management System (HPMS) has been utilized to upload
completed benefit information during the ACRP process. Under MMA and in support of the
bidding process, CMS enhanced the HPMS upload functionality to incorporate the necessary
submission changes to include the formulary to supplement the plan benefit package submission.
CMS continues to improve the PBP software and formulary submission with guidance from
CMS policy and operations groups and the solicitation of industry comment. In Appendix C, the
hardcopy PBP screen prints and formulary submission materials are provided to illustrate a
thorough overview of the tools; however, this information cannot accurately display the
streamlining effect of the tools on the bidding process.
Prior experience coupled with the continued relationship with the industry for the past several
years has helped to further enhance the already user-friendly nature of the plan benefit package
submission process. CMS has maximized the usability of the PBP by using standardized pick
lists, intelligently pre-filled data fields, and integrated online help screens.
Also, the plan benefit package data and its many outputs have served to reduce burden as it
relates to the creation and publication of beneficiary education materials. The PBP serves
primarily as a tool for organizations to describe and report their benefits for the upcoming
contract year. The formulary supplements this information to include the drug lists associated
with the plan’s benefits. However, these data are also central to plan marketing and education
efforts. As a result, CMS chose to take advantage of these data being collected via an electronic
mechanism.
Specifically, CMS developed the PBP so that it standardizes the collection of benefits data. The
formulary and PBP are both used by CMS in the comparative web application tools on
www.medicare.gov that facilitate the comparison of plan choices available to beneficiaries. In
addition, the PBP data is used by CMS to generate plan benefits information in the Medicare &
You handbook. By consolidating this data reporting, CMS is able to use the information to
perform numerous activities without placing additional burden on the organization.
4. Duplication of Similar Information
The information collected in the PBP and formulary is not duplicated through any other CMS
effort. In fact, CMS has eliminated potential duplication by consolidating the collection of plan
benefits data. The collected data are then used to support numerous activities, including the
marketing material review process, the generation of plan marketing materials, and other
program oversight and development activities. Because the PBP and formulary collects the
information that populates the www.medicare.gov website and in the Medicare & You
Handbook, there is no need for organizations to complete multiple marketing data reporting
activities for CMS.
5. Small Businesses
Small businesses are not significantly affected by this collection. Where small businesses may
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participate in these programs, they are required to submit these same data, per statutory
requirements. This software is designed to provide all participating businesses with a
straightforward and efficient method for delivering these data to CMS.
6. Less Frequent Collection
Since CY 2001, CMS has collected the benefit package once a year as required by the Social
Security Act. Under MMA, this collection is now part of the annual bidding process, where
organizations are required to submit their proposed plan benefit packages (including the PBP and
formulary) for the upcoming contract year. In the event that an organization would propose midyear benefit enhancements to their existing plans, propose new plans, or enter the Medicare
program as a new organization, the organization would be required to submit the benefit package
materials during the contract year.
If this collection were not conducted or were conducted less frequently than described above,
there would be adverse consequences, including but not limited to, the following:
•
•
•
•
•
•

Organizations would not be able to increase the number of plan or enhance current plan
choices available to Medicare beneficiaries.
Organizations would not be able to make changes to the formulary that could enhance the
therapeutic options or lower cost-sharing for beneficiaries.
CMS would not be able to accurately or effectively educate Medicare beneficiaries on the
plan choices available to them.
CMS would not be able to effectively review and approve plan marketing materials.
CMS would not be able to effectively review and approve the PBP and formulary, as
required by statute.
Beneficiaries would not receive accurate, updated plan information via the website.

7. Special Circumstances
Organizations may be required to submit benefit data more often under certain circumstances.
Each organization must submit a new PBP and an updated formulary on an annual basis as part
of the annual bidding process. Under certain circumstances, an organization could choose to
enhance an existing plan benefit package mid-year or offer new plans, which would require a
second submission. Additionally, organizations must submit any changes in their formulary
prior to removing a covered Part D drug or when making any change in the preferred or tiered
cost-sharing status of a covered Part D drug as required by the regulations.
8. Federal Register Notice/Outside Consultation
Federal Register
The 60-day notice was published in the Federal Register on October 01, 2018 (83 FR 49389).
Comments were received and are attached to this package along with CMS responses. A number
of the comments received will be considered for future releases of the PBP, or they are outside
the purview of this PRA. However, there were some that were identified as defects.
Most of the 60-day comments received by industry did not necessitate changes to the 30-day
package. However, some changes resulted from internal CMS decisions. These changes are
included in the following screenshots and layouts:
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Appendix_C_CY2020_Formulary_Opioid Strategy Layout
Appendix_C_CY2020_PA_Record_Layout
Appendix_C_CY2020_PAST_Criteria_Change_Request_ Submission
Appendix_C_CY2020_PAST_Criteria_Change_Request_Record_Layout
APPENDIX_C_PBP2020_Screenshots-SectionA-Upload-2018-12-12
APPENDIX_C_PBP2020_Screenshots-SectionB-2018-12-12
APPENDIX_C_PBP2020_Screenshots-SectionB-VBID-UF-SSBCI-2018-12-12
APPENDIX_C_PBP2020_Screenshots-SectionC-2018-12-12
APPENDIX_C_PBP2020-Screenshots-SectionD-2018-12-12
APPENDIX_C_PBP2020-Screenshots-Section-Rx-2018-12-12
APPENDIX_C_PBP2020-Screenshots-Section-Rx-VBID-2018-12-12
Since the PBP changes are a combination of changes that both reduced and added burden, they
did not result in any net burden change for the PBP section. The changes that reduced burden
included, but are not limited to: updating questions in Section A, and removing various proposed
changes. The changes that increased burden include, but are not limited to: the addition of the
Opioid Treatment Services section, and the ability to add more supplemental benefits in section
14c. A number of the changes are adding another selection to a drop down, which does not
impact burden. These changes can be found in the attached List of Changes document under the
CY 2020 PBP Changes section.
Changes to the Formulary were minimal such that the result was no additional burden for the
Formulary section. While there is an addition of 3 new uploads, these updates allow plans to
provide more accurate data to CMS, thus reducing burden or not changing burden. These
changes can be found in the attached List of Changes document under the Formulary Changes
section as well as in the new upload file:
Appendix_C_CY2020_Formulary_Opioid Strategy Layout
Appendix_C_CY2020_PA_Record_Layout
Appendix_C_CY2020_PAST_Criteria_Change_Request_Record_Layout
There are no additional costs to the government or to the plans based on the changes made since
the 60 day package.
While this section of the Supporting Statement compares/contrasts the 60-day package vs. this
30-day package, section 15 below compares/contrasts currently approved requirements and
burden vs. this iteration’s proposed requirements and burden. These changes can be found in the
attached List of Changes.
Outside Consultation
Formulary: CMS and one of its consultants first drafted the formulary submission for use
during CY 2006 by utilizing its considerable experience from the Medicare Prescription Drug
Card program and by conferring with the industry on numerous occasions. CMS requests
comments and feedback from the industry via a lessons learned process annually. The 2020
format is included in the formulary guidelines.
PBP: CMS, with contractor support, prepared the initial draft of the PBP for use during CY
2001 by performing extensive market research, screening, and testing. Since the initial PBP
development, CMS has taken numerous opportunities to confer with representatives from the
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Medicare private plan industry, including MA and PDP organizations and trade groups, to solicit
comments and feedback on the PBP software. CMS has also included internal users of the PBP
data in these efforts. Participants included staff from each CMS Regional Office, Central Office
Medicare Advantage and Prescription Drug staff, and staff from the CMS beneficiary education
campaign. These comment opportunities have included the following:
•

•

•

Beta Testing – The functional test PBP software is distributed to plans for the Beta
testing to allow for hands-on data entry testing and to identify any potential bugs/defects
with the software. CMS is scheduled to hold the PBP 2020 Beta in early February 2019.
This process has occurred each year since the start of the PBP.
Lessons Learned Comments – CMS has implemented a formal process for the
electronic submission of comments and feedback through the HPMS website. The
annual comment period serves as an opportunity to account for lessons learned on the
PBP post production and use. The 2019 Lessons Learned comment period was held from
July 9, 2018 through July 20, 2018.
Ongoing Discussions – As part of our daily business of assisting organizations and
others, CMS has informally received comments concerning the PBP from organizations,
trade associations, Central Office, and Regional Offices.

After collecting and compiling these requests and comments during the various timeframes,
CMS reviews each one and makes a determination as to whether the change should be made in
the software. The CMS review team consists of the agency component areas that serve as
stakeholders for the PBP, including MA and Part D policy and operations, beneficiary education,
and systems. Appendix B provides a detailed list of the changes identified for the PBP software
package and the formulary file for CY 2020 as a result of feedback from the Medicare private
plan industry community and administrative and legislative directives.
Lastly, CMS is providing numerous instructional sessions and user instructions for the PBP and
formulary submission during the upcoming months.
9. Payments/Gifts to Respondents
While there are no monetary payments or gifts to respondents, the approval of the contract for
the organization is an incentive for their participation in the Medicare program.
10. Confidentiality
The information collected through the Plan Benefit Package (PBP) software is considered
proprietary until the bids are approved by CMS for the upcoming contract year (SeptemberOctober timeframe). After bid and contract approval, CMS publishes a subset of PBP data
elements for research and analysis purposes on www.cms.gov.
Information collected through the formulary contains proprietary information, trade secret,
commercial and/or financial information, therefore it is privileged, private to the extent permitted
by law, and protected from disclosure. Formulary supporting documentation is considered
private to the extent permitted by law and will not be disclosed to the public.
These data are protected from disclosure under Exemption 4 of the Freedom of Information Act
(FOIA). Exemption 4 is provided below and is part of the HHA FOIA implementation regulation
(45 CFR Section 5.65) available at: http://www.hhs.gov/foia/45cfr5.html#Subf:
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“Sec. 5.65 Exemption four: Trade secrets and confidential commercial or financial
information. We will withhold trade secrets and commercial or financial information that is
obtained from a person and is privileged or confidential.
Trade secrets. A trade secret is a secret, commercially valuable plan, formula, process, or
device that is used for the making, preparing, compounding, or processing of trade
commodities and that can be said to be the end product of either innovation or substantial
effort. There must be a direct relationship between the trade secret and the productive
process.
Commercial or financial information. We will not disclose records whose information is
“commercial or financial,” is obtained from a person, and is “privileged or confidential.”
Information is “commercial or financial” if it relates to businesses, commerce, trade,
employment, profits, or finances (including personal finances). We interpret this category
broadly.
Information is “obtained from a person” if HHS or another agency has obtained it from
someone outside the Federal Government or from someone within the Government who has
a commercial or financial interest in the information. “Person” includes an individual,
partnership, corporation, association, state or foreign government, or other organization.
Information is not “obtained from a person” if it is generated by HHS or another federal
agency. However, information is “obtained from a person” if it is provided by someone,
including but not limited to an agency employee, who retains a commercial or financial
interest in the information.
Information is “privileged” if it would ordinarily be protected from disclosure in civil
discovery by a recognized evidentiary privilege, such as the attorney-client privilege or the
work product privilege. Information may be privileged for this purpose under a privilege
belonging to a person outside the government, unless the providing of the information to the
government rendered the information no longer protectable in civil discovery.
Information is “confidential” if it meets one of the following tests:
Disclosure may impair the government’s ability to obtain necessary information in the
future;
Disclosure would substantially harm the competitive position of the person who
submitted the information;
Disclosure would impair other government interests, such as program effectiveness and
compliance; or
Disclosure would impair other private interests, such as an interest in controlling
availability of intrinsically valuable records, which are sold in the market by their owner.
The following questions may be relevant in analyzing whether a record meets one or more
of the above tests: Is the information of a type customarily held in strict confidence and not
disclosed to the public by the person to whom it belongs? What is the general custom or
usage with respect to such information in the relevant occupation or business? How many,
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and what types of individuals have access to the information? What kind and degree of
financial injury can be expected if the information is disclosed?”
This information is not published in a manner that identifies individual business decisions, unless
otherwise indicated. Information provided for the CMS beneficiary education campaign (i.e.,
www.medicare.gov and the Medicare & You handbook) is published no earlier than the time
frames required for the legislatively mandated annual enrollment period. The PBP software
identifies for the user the specific data elements that are used for the beneficiary education
campaign.
11. Sensitive Questions
There are no sensitive questions included in this collection effort.
12. Burden Estimate (Total Hours & Wages)
Burden
The estimates for “number of respondents” and “average number of responses per respondent”
are based on the previous years’ bid submissions.
The estimated hour burden for the PBP and formulary submissions for CY 2020 is 65,354.5 total
burden hours, or 114.66 hours per organization.
•
•
•
•
•
•
•
•
•

570 Organization [570 = 532 Medicare Advantage + 38 Prescription Drug Plans]
11 plans/PBPs per organization*
493 Formulary submissions*
6,763 total annual responses [6,763 = 570*11 + 493]
7.75 hours to complete gather of information, data entry, reviewing instructions, and
attending training for the PBP**
34 hours to complete gather of information, data entry, reviewing instructions, and
attending online training for the Formulary**
48,592.5 hours for industry to complete the PBPs [48,592.5= 570*11*7.75]
16,762 hours for industry to complete the Formularies [16,762= 493*34]
65,354.5 total hours for industry to complete entire submission [56,450 = 48,592.5 +
16,762]

An estimate of the annualized cost to the industry in burden hours for the complete submission is
approximately $5,032,296.50 (65,354.5 hours * $77.00 per hour**).
Key
*
Source: HPMS actual data
** Source: Wage based on the results of industry survey of average hourly wage for individuals completing the data
submissions.

Information Collection Documents
•
•
•

PBP Software Screenshots
Formulary File Record Layouts
Crosswalk to the PBP Software and Formulary File
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13. Capital Costs
There is no capital cost needed for this collection effort.
14. Cost to the Federal Government
The initial burden to the Federal government for the collection of the PBP and formulary data
was borne through the development cycle as a one-time cost. The PBP and the formulary are
now in maintenance mode with regard to development and enhancements. The maintenance cost
and the cost to enhance of the PBP and formulary software as well as the cost of CMS
employees’ time are calculated to be: $1,207,520.60. The calculations for CMS employees’
hourly salary were obtained from the OPM website: https://www.opm.gov/policy-data-oversight/payleave/salaries-wages/salary-tables/pdf/2017/DCB_h.pdf (effective January 2017 for the Washington-BaltimoreArlington locality).

Category
PBP - Maintenance and Enhancements

Cost
$678,138.00

Medicare Part D Help PBP:
2 GS-13 (step 5): 2 x $52.66/hr x 20 hours
1 GS -14 (step 5): 1 x $62.23/hr x 20 hours
2 GS -15 (step 5): 2 x $73.20/hr x 10 hours
Subtotal

$2,106.40
$1,244.60
$1,464.00
$4,815.00

Medicare MA Help PBP:
2 GS-15 (step 5): 2 x $73.20/hr x 20 hours
4 GS-13 (step 5): 4 x $52.66/hr x 20 hours
Subtotal
TOTAL PBP COST:

$2,928.00
$4,212.80
$7,140.80
$690,093.80

Formulary - Maintenance and Enhancements
Formulary – Opioid Submission Review

$429,424.60
$82,500

Medicare Part D Help FDR:
3 GS-13 (step 5): 3 x $52.66/hr x 20 hours
1 GS -14 (step 5): 1 x $62.23/hr x 20 hours
1 GS -15 (step 5): 1 x $73.20/hr x 15 hours
Subtotal
TOTAL FORMULARY COST:

$3,159.60
$1,244.60
$1,098.00
$5,502.20
$517,426.80

Total Cost to the Government:

$1,207,520.60

15. Program Changes
The increase to burden is attributable to an increase in the number of actual plans
submitting/PBPs per organization from 10 plans/PBP to 11 plans/PBP, along with an increase in
the number of reporting organizations from 520 to 570, as well as an increase in the number of
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formulary submissions from 475 formularies submitted to 493.
The number of reporting organizations increased from 520 contracts to 570 contracts based on
the most recent numbers extracted from HPMS for organizations planning to provide Medicare
to beneficiaries. This number represents the total number of organizations that will submit at
least one (1) PBP. Because an organization can submit a formulary that covers multiple contract
numbers, only a subset of the 570 organizations will submit distinct formularies.
Cost to the government also increased as a direct result of the increased cost of maintaining and
enhancing the modules, and the increase in employee hourly salaries.
Changes due to internal decisions based on lessons learned are reflected in the screenshots for
the Formulary, PBP and the MTMP and are directly outlined, and referenced in the list of
changes.
Summary of Changes
Category
Respondents
Responses
Time/Response
Hours

ICR Approved on 02/28/2018
520
5,675
9.9
56,450

Proposed Revisions
570
6,763
9.6
65,354.50

16. Publication and Tabulation Dates
Using the plan benefits data entry already completed by the user, the PBP software automatically
generates standardized data in a consistent format that are then displayed to the public through
several mechanisms, including the www.medicare.gov website and the Medicare & You
handbook. The completed formulary is utilized to display drug benefit information on the
www.medicare.gov website.
In all cases below, the organization is required to electronically submit their formulary no later
than the Friday prior to the first Monday of June and the PBP no later than the first Monday of
June. The organization may start developing their formulary at any time and may submit the
formulary as early as mid-May. Additionally, the organization may start developing their PBP
on the first Friday of April.
The following gives a description of each publication of this data:
•

•

CMS Website - The formulary information and standardized benefits data from the PBP
are displayed on an interactive web tool on www.medicare.gov that enables beneficiaries
to compare plan benefit packages. Prior to posting, organizations are allowed to preview
only their own plan benefit data. The initial posting of the benefits data for a new
contract year occurs in mid-October (e.g., posting of CY 2014 data in October 2013).
Medicare & You Handbook - CMS uses a small subset of the PBP data to generate highlevel, limited plan benefits information (e.g. plan name, monthly premium, physician cost
sharing) for the Medicare & You handbook. Organizations are provided a preview
opportunity prior to printing. The initial printing of the plan benefits portion of the
handbook occurs in late September to early October with the handbook being delivered to
Medicare beneficiaries in October.

17. Expiration Date
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CMS has no objections to displaying the expiration date. The expiration date is posted in the
“about PBP” section of the PBP software and under the “OMB clearance” link of the formulary
submission module in HPMS.
18. Certification Statement
There are no exceptions to the certification statement.
B. Collections of Information Employing Statistical Methods
Not Applicable. No statistical methods will be used in this collection effort.

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