CY2026 Plan Benefit Package (PBP) Software and Formulary Submission

CMS Plan Benefit Package (PBP) and Formulary CY 2026 (CMS-R-262) - IRA

OMB: 0938-0763

IC ID: 43667

Documents and Forms

Document Name Document Type
Form CMS-R-262 CY2026 Plan Benefit Package (PBP) Software and Formulary Submission Form and Instruction
CMS-R-262 MTM2026 Mockup Appendix_C_CY2026_MTM_Screenshots.pdf Form and Instruction
CMS-R-262 Benefit Details-Service Categories 1-10 Appendix_C_PBP2026 Benefit Details - Service Categories 1-10.pdf Form and Instruction
CMS-R-262 Benefit Details-Service Categories 11-15 Appendix_C_PBP2026 Benefit Details - Service Categories 11-15.pdf Form and Instruction
CMS-R-262 Cost Share Groups Appendix_C_PBP2026 Cost Share Groups.pdf Form and Instruction
CMS-R-262 General Setup Appendix_C_PBP2026 General Setup.pdf Form and Instruction
CMS-R-262 Section Rx Appendix_C_PBP2026 Section Rx.pdf Form and Instruction
CMS-R-262 VBID Rx Appendix_C_PBP2026 VBID Rx.pdf Form and Instruction
CMS-R-262 VBID-UF-SSBCI Packages Appendix_C_PBP2026 VBID-UF-SSBCI Packages.pdf Form and Instruction
CMS-R-262 CY 2026 Prior Authorization File Record Layout Appendix_C_CY2026_PA_Record_Layout.pdf Form and Instruction
CMS-R-262 Benefit Details - Service Categories 16-20 Appendix_C_PBP2026 Benefit Details - Service Categories 16-20.pdf Form and Instruction