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pdfMEDICARE PART D
REPORTING REQUIREMENTS
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Effective as of January 1, 20256
Contents
Revision History (from Contract Year 2025 to 2026) ....................................................................... 4
Introduction..................................................................................................................................... 5
Timely Submission of Data ..................................................................................................................... 7
Level of Data Reported ........................................................................................................................... 7
Inclusions and Exclusions from Reporting .............................................................................................. 7
Terminations ....................................................................................................................................... 8
No Enrollment Contracts and Plans .................................................................................................... 8
Data Validation ....................................................................................................................................... 8
Reporting Requirements Data Analysis and Limited Data Set ................................................................ 8
Questions ............................................................................................................................................... 9
Reporting Requirements .............................................................................................................. 10
Section I.
Enrollment and Disenrollment ........................................................................................ 10
Section II.
Medication Therapy Management Programs ............................................................. 14
Section III.
Grievances................................................................................................................... 17
Section IV.
Improving Drug Utilization Review Controls.............................................................. 20
Subsection 1: Opioid Care Coordination Safety Edit ......................................................................... 22
Subsection 2: Hard MME Safety Edit ................................................................................................. 22
Subsection 3: Opioid Naïve Days Supply Safety Edit ......................................................................... 23
Section V.
Coverage Determinations, Redeterminations (including At–Risk Redeterminations
under a Drug Management Program), and Reopenings................................................................... 24
Subsection 1a: Coverage Determinations (including exceptions) ...................................................... 27
Subsection 1b: Disposition – Coverage Determinations (non-exceptions) ......................................... 27
Subsection 1c: Disposition – Utilization Management Exceptions ..................................................... 27
Subsection 1d: Disposition – Formulary Exceptions .......................................................................... 27
Subsection 1e: Disposition – Tiering Exceptions ............................................................................... 27
Subsection 2a: Redeterminations including exceptions and at-risk redeterminations) ....................... 27
Subsection 2b: Disposition – Redeterminations (non-exceptions) ..................................................... 28
Subsection 2c: Disposition – Utilization Management Exception Redeterminations .......................... 28
Subsection 2d: Disposition – Formulary Exception Redeterminations ............................................... 28
Subsection 2e: Disposition – Tiering Exception Redeterminations .................................................... 28
Subsection 2f: Disposition – At-Risk Redeterminations ..................................................................... 28
Subsection 3: Reopenings ................................................................................................................ 29
Section VI.
Employer Group Plan Sponsors ................................................................................. 30
Section VII. Medicare Prescription Payment Plan ........................................................................... 32
Subsection 1: Likely to benefit identification ...................................................................................... 34
Subsection 2: Election request processing ........................................................................................ 34
Subsection 3: Unsettled balances ..................................................................................................... 35
Revision History (from Contract Year 2025 to 2026)
The following list is provided as a courtesy and includes certain changes to this
document made between Contract Year (CY) 2025 and CY 2026. Please compare the
documents from both years for all changes between the two CYs.
1. Formatting changes have been made throughout the document, including listing
data elements in tables instead of lists.
2. Additional information on timely submission of data has been addedincluded toin
the introduction. This information used to be found in the Technical
Specifications.
3. Clarification of definitions of level of data to be reported has been added to the
introduction.
4. Additional information on inclusions and exclusions from Reporting Sections has
been included in the introduction.
5. Clarification has been added to the introduction about terminated contracts and
contracts/plans with no enrollment.
6. Additional information on Data Validation has been added to the introduction.
7. Information has been added to the introduction on CMS Analysis of Reporting
Requirements data and publication of the Limited Data Set.
8. The new mailbox for questions about Part D Reporting Requirements has been
added to the introduction.
9. Tables describing which contracts and plan types are required to report each
reporting section have been added for clarity.
10. Duplicative information has been removed, including information duplicative of
the Technical Specifications.
11. Certain introductory information in each Reporting Requirements sections has
been removed if it was duplicative of information found in cited regulations/policy
guidance.
12. Minor clarifications have been madeto lists of data elements into most Reporting
Requirements sections’ data elements.
Introduction
Section 1860D–12(b)(3)(D) of the Social Security Act (the Act) provides broad authority
for the Secretary to add terms to the contracts with Part D sponsors, including terms that
require the sponsor to provide the Secretary with information as the Secretary may find
necessary and appropriate. Pursuant to our statutory authority, we codified these
information collection requirements for Part D sponsors in regulation at 42 CFR
§423.514.
42 CFR §423.514(a) requires each Part D sponsor to have an effective procedure to
develop, compile, evaluate, and report to the Centers for Medicare & Medicaid Services
(CMS)CMS, to its enrollees, and to the general public, at the times and in the manner
that CMS requires, statistics information indicating the following:
1)
2)
3)
4)
5)
6)
The cost of its operations.
The patterns of utilization of its services.
The availability, accessibility, and acceptability of its services.
Information demonstrating that the Part D sponsor has a fiscally sound operation.
Pharmacy performance measures.
Other matters that CMS may require.
Unless otherwise specified, drug utilization data should include all covered 1 Part D
drugs, including compounded drugs.
0F
Commented [SS1]: This used to be a * but has been
changed to an actual footnote.
This document lists data elements for each reporting section, reporting timeframes,
deadlines, and required levels of reporting.
The purpose of this document is to assure a common understanding of the Part D
reporting requirements and how these data will be used to monitor the prescription drug
benefit provided to Medicare beneficiaries. CMS will use the following terminology to
ensure consistency in these reporting requirements:
Commented [SS2]: We agreed to remove this
sentence.
Commented [SS3]: These Plan and Contract
descriptions have been rewritten for clarity in the Level
of Data Reported section of this introduction.
Part D sponsor –an organization which has one or more contract(s) with CMS to provide
Part D benefits to Medicare beneficiaries. Each contract is assigned a CMS contract
number (e.g., H# or S#).
Plan – a plan benefit package (PBP) offered within a Part D contract (e.g., Plan ID #).
This document lists reporting timeframes, deadlines and required levels of reporting.
Reporting deadlines may occur in the subsequent calendar year. Data elements may be
reported at the Plan (PBP) level, or the individual Contract level.
The following criteria were used in selecting reporting requirements:
Minimal administrative burden on Part D sponsors;
1 Covered Part D drugs as defined by Section 1860D-2(e)(2) of the Social Security Act (The Act). Drugs
offered under enhanced or supplemental drug benefits by sponsors are not covered Part D drugs.
Commented [SS4]: We agreed to remove this
selection criteria, as it is duplicative of information in
PRA materials.
Legislative and regulatory authority;
Validity, reliability, and utility of data elements requested; and
Wide acceptance and current utilization within the industry.
PACE Organizations offering Part D coverage are exempt from these Part D reporting
requiremen 2ts.
1F
Unless otherwise specified, drug utilization data should include all covered* Part D drugs, including
compounded drugs
2
Commented [SS5]: This was removed as it was
duplicative of the new and improved Inclusions and
Exclusions sections of this introduction.
Medicare/Medicaid Plans (MMPs) should refer to the Medicare-Medicaid Financial
Alignment Model Reporting Requirements for additional reporting guidance. Some MMP
measures may have specific timelines that may be different.
*Covered Part D drugs as defined by Section 1860D-2(e)(2) of the Social Security Act
(The Act). Drugs offered under enhanced or supplemental drug benefits by sponsors
are not covered Part D drugs.
Timely Submission of Data
Most reporting sections will be reported annually. Reporting deadlines often occur in the
subsequent calendar year. Reporting deadlines and frequencies are listed in the
Reporting Requirement sections below. Data submissions are due by 11:59 p.m. Pacific
Time on the date of the reporting deadline.
Part D sponsors must report all data based on the most current Reporting
Requirements documentation as of the reporting deadline. Part D sponsors should be
able to support the accuracy of their data submissions based on their understanding of
the Reporting Requirements documentation. Sponsors should retain documentation
supporting their Health Plan Management System (HPMS) data submissions and
resubmissions. Sponsors must retain this complete archive for the 10-year retention
period required per federal regulations and be prepared to provide the archive to CMS
upon request.
Commented [SS6]: Removed as these do not exist in
2026.
Commented [SS7]: The following sections of the
introduction are set to match exactly to the Part C RR
doc, except in specific minor instances where C and D
differ.
Commented [SS8]: From Part D TS.
Level of Data Reported
Data elements may be reported at the Plan-level, or the individual Contract-level.
Contract-level reporting indicates data should be entered at the H#, S#, R#, or E#
level. Plan-level reporting indicates data should be entered at the Plan Benefit
Package (PBP) level (e.g., Plan 001 for contract H#, R#, S#, or E#). Plan-level
reporting is necessary to conduct appropriate oversight and monitoring of some
areas. Level of reporting is listed in the Reporting Requirement sections below.
Inclusions and Exclusions from Reporting
Organization types required to report data are listed in the Reporting Requirements
sections below. The following organization types are excluded from reporting all
Part D Reporting Requirements:
1. Medicare Savings Accounts (MSAs) 3
2. Demonstration Plans
2F
Denotes that these the plans are required to report the Employer Group Plan Sponsors reporting
section, because this section is reported by both Part C and Part D plans.
3
Commented [SS9]: We discussed this as a team, even
with Bene or case level reporting, we are only
referencing the top level reporting (contract or plan).
3. Healthcare Prepayment Plan (HCPP) – 1833 Cost Plans
4. National PACE Plans
5. Fallback Plans
Terminations
If a contract terminates before July 1 in the following year after the CY reporting period,
the contract must not report data for the respective two years – the CY reporting period,
and the following year.
•
Example: Contract terminates June 20XX. The contract willmust not report CY
20XX - 1 (“CY reporting period”) or CY 20XX data (“following year”).
If a PBP (Plan) under a contract terminates at any time in the CY reporting period and
the contract remains active through July 1 of the following year, the contract must still
report data for all PBPs, including the terminated PBP.
No Enrollment Contracts and Plans
Contracts or plans with no enrollment must not report data for any reporting section. No
enrollment signifies that the contract has no enrollees for all months within the reporting
period.
Data Validation
CMS requires that sponsoring organizations (SOs) contracted to offer Medicare Part C
and/or Part D benefits be subject to an independent yearly audit to validate certain data
reported to CMS to determine its reliability, validity, completeness, and comparability in
accordance with specifications developed by CMS. 4
3F
Reporting Sections requiring data validation are indicated in the Reporting Requirement
sections below. More information about data validation can be found at
https://www.cms.gov/medicare/coverage/prescription-drug-coverage-contracting/part-c-andpart-d-data-validation.
Reporting Requirements Data Analysis and Limited Data Set
CMS analyses data submitted for accuracy and trends. In addition, certain data reported
by Part D Sponsors is published annually in a Limited Data Set (LDS). More information
on this LDS can be found at https://www.cms.gov/data-research/files-order/limited-dataset-lds-files/parts-c-and-d-reporting-requirements-limited-data-set.
4
See 42 CFR § 422.516(g) and § 423.514(j)
Commented [SS10]: Agreed as a team for 2026, all
RR sections will adopt the same rule as MTM. No
enrollment contracts will NOT show up for any
reporting section. No enrollment contracts will not
report data. Their contract number would not even
show up in the HPMS.
Commented [SS11]: We agreed as a team to use the
same language that is in the DV manual.
Questions
Questions about Part D Reporting Requirements should be sent via email to
PartsCDPlanReportingAndDV@cms.hhs.gov.
Reporting Sections
Section I.
Enrollment and Disenrollment
Enrollment and disenrollment requirements for Medicare Advantage (MA) and Part D
plan elections are outlined at 42 CFR 422 Subpart B and 42 CFR 423 Subpart B,
respectively.
CMS will collect data on the elements for these requirements, which are otherwise not
available to CMS, in order to evaluate sponsors’ processing of enrollment,
disenrollment, and reinstatement requests in accordance with CMS requirements.
All enrollment and disenrollment activity involving a Part D benefit (e.g., standalone
prescription drug plans (PDPs), MA prescription drug plans (MA-PDs) prescription drug
plan, 1876 Ccost plans with Part D optional supplemental benefit) is reported via the
Part D Reporting Rrequirements. MA MAOrganizations and 1876 Cost plans report
enrollment and disenrollment activity that does not involve a Part D benefit under the
Part C Rreporting Rrequirements.
Commented [SS12]: Agreed as a team to remove this,
as it is fluff. The introductions should just be citations of
policy/regs, possible links if relevant.
Section 1 Enrollment, elements 1.A-1.K must include all enrollments. Disenrollments
must not be included in Section 1 Enrollment. Section 2 Disenrollment, elements 2.A2.F, must include all voluntary disenrollment transactions.
Reporting
Period
Data due to
CMS/HPMS
Commented [SS13]: Removed and moved to TS.
Period 1
January 1 – June 30
Period 2
July 1 – December 31
Last Monday of August
Last Monday of February
For more
information
on these
requiremen
ts, refer to
the MA and
Part D Enrollment and Disenrollment Guidance, available at:
https://www.cms.gov/medicare/enrollment-renewal/part-d-enrollment-eligibility.
Reporting timeline:
Organization Types
Required to Report
-
Report
Frequency,
Level
2/Year
Local Coordinated Care
Plan (CCP)
Religious Fraternal
Benefit (RFB) Private Fee Contract Level
for Services (PFFS)
PFFS
1876 Cost
Prescription Drug Plans
(PDPs)
Report
Period(s)
Data Due Date(s)
Period 1:
1/1-6/30
Period 2:
7/1-12/31
Period 1: Last Monday of
August
Period 2: Last Monday of
February of the following
year.
Data Validation not
required.
(Reporting
at the
biannual
level)
Commented [SS14]: Copied from Part C RR doc.
-
Regional CCP
RFB Local CCP
Data files to be uploaded through the HPMS at the Contract level, following templates provided
in HPMS.
Commented [SS15]: Sentences like these have been
removed as they are duplicative of the TS.
Subsection 1: Enrollment
Data
Element ID
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Data Element Description
The total number of enrollment requests (initiated by the beneficiary or
his/her authorized legal representative) received in the reporting period.
Do not include auto/facilitated or passive enrollments, rollover
transactions, or other enrollments effectuated by CMS.
Of the total reported in Element A, the number of enrollment requests
complete at the time of initial receipt (i.e., required no additional
information from applicant or his/her authorized representative).
Of the total reported in Element A, the number of enrollment requests
that were not complete at the time of initial receipt and for which the
sponsor was required to request additional information from the
applicant (or his/her authorized representative).
Of the total reported in Element A, the number of enrollment requests
denied due to the sponsor’s determination of the applicant’s ineligibility
to elect the plan (i.e. individual not that the applicant was not eligible for
an election period).
Of the total reported in Element C, the number of enrollment requests
received that are incomplete upon initial receipt and completed within
established timeframes.
Of the total reported in Element C, the number of enrollment requests
denied due to the applicant or his/her authorized legal representative
not providing the information required to complete the enrollment
request within established timeframes.
Of the total reported in Element A, the number of paper enrollment
requests received.
Of the total reported in Element A, the number of telephonic enrollment
requests received (if sponsor offers this mechanism).
Of the total reported in Element A, the number of electronic enrollment
requests received via an electronic device or secure internet website (if
sponsor offers this mechanism).
Of the total reported in Element A, the number of Medicare Online
Enrollment Center (OEC) enrollment requests received.
Of the total reported in Element A, the number of enrollment requests
received from an applicant through an agent or broker.
Subsection 2: Disenrollment
Data
Element ID
Data Element Description
A.
The total number of voluntary disenrollment requests received in the
reporting period. Do not include disenrollments resulting from an
individual’s enrollment in another plan.
Of the total reported in Element A, the number of disenrollment requests
complete at the time of initial receipt (i.e., required no additional
B.
Commented [SS16]: Data Elements have been moved
into table format instead of a list.
Commented [SS17]: We ensured we always say
“authorized representative” so that we are consistent
between C and D rr docs. Note that while the Part C
reg says “authorized representative”, the Part D reg
just says “Representative”.
Commented [SS18]: Slight edits made throughout to
match Part C document.
Data
Element ID
C.
D.
E.
F.
G.
H.
I.
J.
Data Element Description
information from enrollee or his/her authorized representative).
Of the total reported in Element A, the number of disenrollment requests
that were not complete at the time of initial receipt.
Of the total reported in Element A, the number of disenrollment requests
denied by the Sponsor for any reason. due to the sponsor’s
determination that the enrollee was not eligible for an election period.
Of the total reported in Element C, the number of disenrollment requests
received that are incomplete upon initial receipt and completed within
established timeframes.
Of the total reported in Element C, the number of disenrollment requests
denied due to the enrollee or his/her authorized legal representative not
providing information required to complete the disenrollment request
within established timeframes.
The total number of involuntary disenrollments for failure to pay plan
premium in the reporting period.
Of the total reported in Element G, the number of disenrolled individuals
who submitted a timely request for reinstatement for Good Cause.
Of the total reported in Element H, the number of favorable Good Cause
determinations.
Of the total reported in Element I, the number of individuals reinstated.
Commented [SS19]: FYI, Part C description says “the
number of disenrollment requests denied by the
Sponsor for any reason.” SME agreed to say that here.
Section II.
Medication Therapy Management Programs
Per 42 CFR § 423.153(d), The requirements stipulating that Part D sponsors must
establish provide Medication Therapy Management (MTM) programs. More information
about Part D MTM programs can be found at:
https://www.cms.gov/medicare/coverage/prescription-drug-coveragecontracting/medication-therapy-management. are described in Title I, Part 423, Subpart
D, § 423.153. For monitoring purposes, Part D sponsors must will be responsible for
reporting several data elements related to all beneficiaries enrolled in their MTM
program.
Reporting timeline:
Reporting Period
Data due to CMS/HPMS
YTD
January 1 - December 31
Last Monday of February
Sponsors are required to target beneficiaries for the MTM program who meet specific
criteria as specified by CMS in § 423.153(d)(2). Some sponsors also offer enrollment in
the MTM program to an expanded population of beneficiaries who do not meet the
targeting criteria under § 423.153(d)(2).
The following information will be collected for each beneficiary identified as being
eligible for the Part D MTM program, whether based on CMS’ specifications or other
plan-specific expanded targeting criteria within the reporting period. Regardless of this
designation, the corresponding MTM services delivered to each beneficiary (such as
targeted medication review or comprehensive medication review) must meet CMS
definitions. The reported beneficiaries must receive MTM services that meet or exceed
CMS’ MTM program requirements.
Organization Types Required Report
to Report
Frequency,
Level
1/ Year
All contracts identified in the
approved drill down of the CY Contract Level
of the reporting year in the
MTMP Activity Report.
Data
Element ID
Commented [SS20]: Removed as we agreed with
SMEs that this is mentioned in both the first and
second paragraph so one mention can be deleted.
Data Element Description
Report
Period(s)
Data Due
Date(s)
Period1: 1/112/31
Last Monday of
February of the
following year.
(Reporting at
the annual
level)
Data Validation is
required.
Commented [SM21]: We struck this to keep it simple
so that we do not have to update if requirements
change.
Commented [SS22]: This has been moved to TS.
Data
Element ID
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
Data Element Description
Contract Number.
MBI Number.
Beneficiary first name.
Beneficiary last name.
Beneficiary date of birth.
Beneficiary identified as cognitively impaired at time of comprehensive
medication review (CMR) offer or delivery of CMR. (Y (yes), N (no), or U
(unknown)).
Beneficiary in a long- term care facility at the time of the first CMR offer
or delivery of CMR? (Y (yes), N (no), or U (unknown))
Date of MTM program enrollment.
Targeting criteria met. Required if met the specified targeting criteria per
CMS – Part D requirements in § 423.153(d)(2). (Multiple chronic
diseases/multiple Part D drugs/cost threshold; Drug management
program at-risk beneficiary; Both; None).
Date met the specified targeting criteria per CMS – Part D requirements
in § 423.153(d)(2). Required if met the specified targeting criteria per
CMS – Part D requirements. (May be same as Date of MTM program
enrollment).
Date of MTM program opt-out, if applicable
Reason participant opted-out of MTM program (Death; Disenrollment
from Plan; Request by beneficiary; or Other). Required if Date of MTM
program opt-out is applicable.
Offered annual CMR. (Y (yes) or N (no)). Required if met the specified
targeting criteria per CMS – Part D requirements.
If offered a CMR, date of (initial) offer.
Received annual CMR with written summary in CMS standardized
format. (Y (yes) or N (no)). Required if offered annual CMR.
Date(s) of CMR(s). (If more than 1 CMR is received, report the date of
the initial CMR.). Required if received annual CMR.
Date CMR written summary in CMS standardized format was provided
or sent. (If more than 1 CMR was performed, report the date the initial
CMR written summary was provided or sent.).
Method of delivery for the annual CMR. (In-Person; Synchronous
Telehealth – telephone; Synchronous Telehealth – video conferencing;
Other real-time method). (If more than 1 CMR is received, report the
method of delivery for the initial CMR). Required if received annual
CMR.
Qualified Provider who performed the initial CMR. (Physician;
Registered Nurse; Licensed Practical Nurse; Nurse Practitioner;
Physician’s Assistant; Local Pharmacist; LTC Consultant Pharmacist;
Plan Sponsor Pharmacist; Plan Benefit Manager (PBM) Pharmacist;
MTM Vendor Local Pharmacist; MTM Vendor In- house Pharmacist;
Hospital Pharmacist; Pharmacist – Other; Supervised Pharmacy Intern;
Commented [SS23]: Data Elements have been moved
into table format instead of a list.
Data
Element ID
T.
U.
V.
W.
X.
Y.
Z.
Data Element Description
or Other). Required if received annual CMR.
Recipient of initial CMR. (Beneficiary, Beneficiary’s prescriber;
Caregiver; or Other authorized individual). Required if received annual
CMR.
Number of targeted medication reviews. Required if met the specified
targeting criteria per CMS – Part D requirements.
Date the first TMR was performed.
Number of medication therapy problem recommendations made to
beneficiary’s prescriber(s) as a result of MTM services.
Number of medication therapy problem resolutions resulting from
recommendations made to beneficiary’s prescriber(s) as a result of
MTM recommendations.
Number of communications sent to beneficiary regarding safe disposal
of medications. Required if met the specific targeting criteria per CMS –
Part D requirements.
Method of delivery for information regarding safe disposal of
medications (CMR; TMR; Welcome Letter; Other). If more than one
communication is sent, report the method of the initial communication.
Section III.
Grievances
Part D sponsors must comply with grievance requirements for timely hearing and resolving of
grievances as established in the regulations at 42 CFR Part 423 Subpart M and further
described in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and
Appeals Guidance. Title 42, Part 423, Subpart M describes Part D sponsors requirements for
grievances, including timeframes for standard and expedited requests.
Sponsors should:
Commented [SS25]: This has been moved to the TS.
Report data based on when the enrollee/enrollee representative is notified (orally or
written) of the grievance decision.
Track multiple grievances by a single complainant and report as separate grievances.
Sponsors should not:
Include CTM data when reporting grievances.
Report general inquiries or questions that do not include a complaint as grievances.
Include grievances filed by prospective enrollees.
Report withdrawn grievances.
Organization Types Required
to Report
-
Local CCP
RFB PFFS
PFFS
1876 Cost
PDP
Regional CCP
Employer/Union Only Direct
Contract PDPs
Employer/Union Only
Direct Contract – PFFS
RFB Local CCP
LI NET Sponsor
Employer/Union Only Direct
Contract Local CCP
Organizations should include all
800 series plans.
Commented [SS24]: Updates in citations
provided/approved by SMEs.
Report
Frequency,
Level
1/Year
Contract Level
Report
Period(s)
Data Due
Date(s)
Q1: 1/1-3/31
Q2: 4/1- 6/30
Q3: 7/1-9/30
Q4: 10/1-12/31
First Monday of
February of the
following year.
(Rreporting at
quarterly level)
Data Validation
required.
Employer/Union Direct Contracts
should also report this reporting
section, regardless of
organization type.
Sponsors will report quarterly data on an annual basis. Data files to be
uploaded through the HPMS at the Contract level, following templates
provided in HPMS.
Reporting timeline:
Reporting
Period
Data due to
CMS/HPMS
Quarter 1
January 1 March 31
First Monday
of February
(reporting for
all quarters
due on this
date)
Quarter 2
April 1 June 30
First Monday
of February
(reporting for
all quarters
due on this
date)
Quarter 3
July 1 September 30
First Monday
of February
(reporting for
all quarters due
on this
date)
Commented [SS26]: Removed as this is duplicative
info.
Quarter 4
October 1 December 31
First Monday of
February
(reporting for all
quarters due on
this
date)
Data elements should be uploaded to HPMS at the Contract level:
Data
Data Element Description
Element ID
A.
Number of Total Grievances
B.
Number of Total Grievances in which timely notification was given
C.
Number of Expedited Grievances
D.
Number of Expedited Grievances in which timely notification was
given
E.
Number of Dismissed Grievances
Commented [SS27]: This is duplicative of the table
above, removing.
Commented [SS28]: Data Elements have been moved
into table format instead of a list. No changes to the
elements were made.
Section IV. Improving Drug Utilization Review Controls
Part D sponsors must have concurrent drug utilization review (DUR) systems, policies,
and procedures designed to ensure that a review of the prescribed drug therapy is
performed before each prescription is dispensed to an enrollee in a sponsor’s Part D
plan, typically at the point-of-sale (POS) or point of distribution as described in 42 CFR
§ 423.153(c)(2). To help prevent and combat prescription opioid overuse through
improved concurrent DUR, sponsors are expected to implement opioid safety edits at
the POS. More information about Medicare Part D opioid overutilization policies can be
found at https://www.cms.gov/medicare/coverage/prescription-drug-coveragecontracting/improving-drug-utilization-review-controls-part-d.
For monitoring, Part D sponsors must report will report cumulative YTD data by quarter to
CMS on the beneficiaries who triggered each of the following opioid safety edits:
Commented [SM29]: Edits were made to point to this
page and streamline.
An opioid care coordination safety edit, at 90 morphine milligram equivalent dose
(MME)hard MME, and the opioid naïve days supply safety edits. per day;
https://www.cms.gov/medicare/coverage/prescriptiondrug-coverage-contracting/improving-drug-utilizationreview-controls-part-d
An optional hard formulary-level cumulative opioid daily MME safety edit at 200 MME or
more;
A hard opioid naïve days supply safety edit for initial opioid prescriptions fills that exceed
7 days for the treatment of acute pain.
All data elements must be uploaded to HPMS at the Contract level. These elements will
enable CMS to monitor sponsors’ implementation of the opioid point-of-sale (POS)
safety edits as well as the impact and outcome of the edits aggregated at both the claim
and unique beneficiary levels (i.e., based on count of unique Medicare Beneficiary
Identifiers (MBIs)).
Organization Types
Required to Report
-
Local CCP
RFB PFFS
PFFS
1876 Cost
PDP
Regional CCP
Employer/Union
Only Direct Contract
PDPs
Employer/Union
Only Direct
Contract PFFS
Report
Frequency,
Level
Report
Period(s)
Data Due
Date(s)
1/Year
Q1: 1/1-3/31
Q2: 14/1- 6/30
Q3: 17/1-9/30
Q4: 10/1-12/31
Last Monday of
February of the
following year.
Contract Level
(Rreporting at
the quarterly
level)
Data Validation
required.
Commented [SM30]: Worked with Joanne to make
edits to decide if this information can be struck since
we added the cms.gov website where the actual OMS
policies are described.
Commented [SS31]: Removed as this information is
now in the Tech Specs.
Commented [MK32]: Moved to TS.
-
RFB Local CCP
Employer/Union Only
Direct Contract Local
CCP
Commented [SS33]: We agreed to add the below
language to Part D sections requiring employer plans
to report for consistency with Part C sections do.
“Organizations should include all 800 series plans.
Employer/Union Direct Contracts should also report
this reporting section, regardless of organization type.”
Organizations should include
all 800 series plans.
We will ensure this update is made to 2026
parameters.
Employer/Union Direct
Contracts should also report
this reporting section,
regardless of organization type.
Reporting timeline:
Reporting
Period
Data due to
CMS/HPMS
Quarter 1
January 1 March 31
Last Monday
of February
(reporting for
all quarters
due on this
date)
Quarter 2
January 1 June 30
Last Monday
of February
(reporting for
all quarters
due on this
date)
Quarter 3
January 1 September 30
Last Monday of
February
(reporting for
all quarters due
on this date)
Quarter 4
January 1 December 31
Last Monday of
February
(reporting for
all quarters due
on this date)
Subsection 1: Opioid Care Coordination Safety Edit at 90 MME
Data
Element ID
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Data Element Description
The prescriber count criterion used, if applicable.
The pharmacy count criterion used, if applicable.
The number of claims rejected due to the care coordination edit.
Of the total reported in Eelement C, the number of claim rejections
overridden by the pharmacy.
Of the total reported in Element D: The number of claim rejections
overridden by the pharmacy within 24 hours of the initial claim rejection.
Of the total reported in Element D: The number of claim rejections
overridden by the pharmacy due to an exemption.
Of the total reported in Element D but Of the total not in Eelement F:,
Tthe number of claim rejections overridden by the pharmacy as a result
of prescriber consultation.
Of the total reported in Element CD: The number of unique beneficiaries
with at least one claim rejected due to the care coordination edit.
Of the total reported in Element H: The number of unique beneficiaries
with at least one claim rejection overridden by the pharmacy.
Of the total reported in Element H: The number of unique beneficiaries
with at least one claim rejection overridden by the pharmacy within 24
hours of the initial claim rejection.
Of the total reported in Element H: The number of unique beneficiaries
with at least one claim rejection overridden by the pharmacy due to an
exemption.
Of the total reported in Element H but not inOf the total not in Eelement
K:, Tthe number of unique beneficiaries with at least one claim rejection
overridden by the pharmacy as a result of prescriber consultation.
Commented [JH34]: Removing specification of CC
edit similar to above.
Commented [SS35]: Data Elements have been moved
into table format instead of a list.
Commented [SM36]: General note that we can save
for 2027 RR document(s) - I don’t think we are
consistent with the “Of the total” for other sections. One
example - part C ODR.
Commented [SM37]: Joanne confirmed this should be
Of the total reported in Element C.
Commented [SS38]: “Of the total reported in element
H:" was moved directly into the description of each
element to avoid unnecessary breaks in the list/table
for 508 purposes.
Subsection 2: Hard MME Safety Edit
Data
Element ID
M.
N.
O.
P.
Q.
R.
S.
Data Element Description
Did the plan have a hard MME edit in place during the time period
above? (Y (yes) or N (no)).
If yes to Element M: The cumulative MME threshold used.
If yes to Element M: The prescriber count criterion used, if applicable.
If yes to Element M: The pharmacy count criterion used, if applicable.
If yes to Element M: The number of claims rejected due to the hard
MME edit.
If yes to Element M: The number of unique beneficiaries with at least
one claim rejected due to the hard MME edit.
If yes to Element M: Of the total reported in Eelement R, the number of
unique beneficiaries with at least one claim rejection overridden by the
pharmacy due to an exemption.
Commented [SS39]: “If yes to Element M:" was moved
directly into the description of each element to avoid
unnecessary breaks in the list/table for 508 purposes.
Data
Element ID
T.
U.
Data Element Description
If yes to Element M: Of the total reported in Eelement R and not in
element S, the number of unique beneficiaries who requested a
coverage determination for the prescription(s) subject to the edit.
If yes to Element M: Of the total reported in Eelement T, the number of
unique beneficiaries that had a favorable (either full or partial) coverage
determination for the prescription(s) subject to the edit.
Subsection 3: Opioid Naïve Days Supply Safety Edit
Data
Element ID
V.
W.
X.
Y.
Z.
AA.
BB.
CC.
DD.
EE.
FF.
Data Element Description
The look-back period used to identify an initial opioid prescription fill for
the treatment of acute pain for the opioid naïve days supply edit.
The number of claims rejected due to the opioid naïve days supply edit.
Of the total reported in Element W: The number of rejected claims
overridden by the pharmacy due to an exemption.
Of the total reported in Element W: The number of rejected claims
overridden by the pharmacy because the beneficiary was not opioid
naïve.
Of the total reported in Element W butOf the total not in Eelements X or
Y:, Tthe number of rejected claims for which up to a 7 day supply
(covered by the plan) was dispensed by the pharmacy.
Of the total reported in Element W: The number of unique beneficiaries
with at least one claim rejected due to the opioid naïve days supply edit.
Of the total reported in Element AA: The number of unique beneficiaries
with at least one rejected claim overridden by the pharmacy due to an
exemption.
Of the total reported in Element AA: The number of unique beneficiaries
with at least one rejected claim overridden by the pharmacy because the
beneficiary was not opioid naive.
Of the total reported in Element AA but not in Elements BB or CC: The
number of unique beneficiaries for whom up to a 7 day supply (covered
by the plan) was dispensed by the pharmacy.
Of the total reported in Element AA: The number of unique beneficiaries
with an opioid naïve days supply edit claim rejection who requested a
coverage determination for the prescription(s) subject to the edit.
Of the total reported in Element EE: Of the total in element EE, Tthe
number of unique beneficiaries with an opioid naïve days supply edit
claim rejection who had a favorable (either full or partial) coverage
determination for the prescription(s) subject to the edit.
Commented [SS40]: “Of the total reported in element
W:" was moved directly into the description of each
element to avoid unnecessary breaks in the list/table
for 508 purposes.
Commented [SS41]: “Of the total reported in element
AA:" was moved directly into the description of each
element to avoid unnecessary breaks in the list/table
for 508 purposes.
Section V. Coverage Determinations, Redeterminations (including At–Risk
Redeterminations under a Drug Management Program), and Reopenings
The requirements relating to coverage determinations (including formulary and tier
exceptions, and exceptions to established drug utilization management programs) and
redeterminations, including timeframes for standard and expedited requests are
described in Title 42, Part 423, Subpart M. Sponsors will be responsible for reporting
several data elements related to coverage determinations and redeterminations,
including Part B vs. Part D coverage determinations and redeterminations. Sponsors
should report data based on the date the enrollee/enrollee’s representative is notified in
writing of the coverage determination or redetermination decision. A sponsor’s complete
decision includes making the determination, appropriately notifying the enrollee of the
determination, and authorizing coverage or sending payment, where applicable.
For CMS provides further clarity regarding specific requirements for Part D sponsors,
please see https://www.cms.gov/medicare/appeals-grievances/prescription-drug.
Coverage decisions (both coverage determinations and redeterminations) may result in
a partially favorable decision.
Commented [SS42]: Some deletions made if
duplicative of policy.
Example of a fully favorable decision: Non-formulary exception request approved for
drug and quantity prescribed.
Example of a partially favorable decision: Non-formulary exception request approved for
drug, but full quantity prescribed not approved.
Sponsors must also report dataRequirements relating tofor redeterminations of at-risk
determinations made under a plan sponsor’s drug management program pursuant to
the rules atare described at 42 CFR § 423.153(f). , including the number of requests
and the disposition. At-risk redeterminations may involve decisions about:
Being identified as an at-risk beneficiary for prescription drug misuse or abuse;
Having a limitation, or the continuation of a limitation, on access to coverage for
frequently abused drugs (i.e., an enrollee specific point-of-sale (POS) edit or the
selection of a prescriber and/or pharmacy for purposes of lock-in);
Sharing information for subsequent Part D plan enrollments.
Sponsors should report data based on the date the enrollee/enrollee’s representative is
notified in writing of the at-risk redetermination decision.
Title 42, Part 423, Subpart U describes requirements for reopenings of coverage
determinations and redeterminations. Sponsors should also include reopened coverage
determination and redetermination data, based on the date the enrollee/enrollee’s
representative is notified in writing of the revised decision. A reopening may or may not
change the disposition of the case.
Commented [SS43]: Removed as it is duplicative of
TS.
Commented [AL44]: Striking, out of scope for this RR
document, encompassed in the reg and guidance
citations.
Sponsors will report quarterly data on an annual basis at the Contract level.
Data files to be uploaded through the HPMS at the Contract level, following
templates provided in HPMS.
Organization Types
Required to Report
-
Local CCP
RFB PFFS
PFFS
1876 Cost
PDP
Regional CCP
Employer/Union Only
Direct Contract PDPs
Employer/Union Only
Direct Contract PFFS
RFB Local CCP
Employer/Union Only
Direct Contract Local
CCP
Report
Frequency,
Level
Report Period(s)
Data Due Date(s)
1/Year
Q1: 1/1-3/31
Q2: 4/1- 6/30
Q3: 7/1-9/30
Q4: 10/1-12/31
Last Monday of
February of the
following year.
Contract Level
(Rreporting at
quarterly level)
Data Validation
required.
Organizations should
include all 800 series plans.
Employer/Union Direct
Contracts should also report
this reporting section,
regardless of organization
type.
Reporting timeline:
Reporting
Period
Quarter 1
January 1 March 31
Quarter 2
April 1 June 30
Quarter 3
Quarter 4
July 1 October 1 September 30 December 31
Data due to
CMS/HPMS
Last Monday
of February
(reporting for
all quarters
due on this
date)
Last Monday
of February
(reporting for
all quarters
due on this
date)
Last Monday of Last Monday of
February
February
(reporting for all (reporting for all
quarters due on quarters due on
this
this
date)
date)
Subsection 1a: Coverage Determinations (including exceptions)
Data
Data Element Description
Element ID
A.
Total Number of Coverage Determinations Processed (including
exceptions)
B.
Total Number of Withdrawn Coverage Determinations
C.
Total Number of Dismissed Coverage Determinations
Commented [SS45]: The format of these tables has
been fixed to align with 508 standards. There are now
2 columns instead of 1. There are now column
headers. Sub headings have been broken out into
separate tables.
Subsection 1b: Disposition – Coverage Determinations (non-exceptions)
Data
Element ID
D.
E.
F.
Data Element Description Description
The total number of fully favorable decisions.
The total number of partially favorable decisions.
The total number of adverse decisions.
Subsection 1c: Disposition – Utilization Management Exceptions
Data
Data Element Description
Element ID
G.
The number of utilization management exceptions.
H.
The number of fully favorable decisions.
I.
The number of partially favorable decisions.
J.
The number of adverse decisions.
Subsection 1d: Disposition – Formulary Exceptions
Data
Element ID
K.
L.
M.
N.
Data Element Description
The number of formulary exceptions.
The number of fully favorable decisions.
The number of partially favorable decisions.
The number of adverse decisions.
Subsection 1e: Disposition – Tiering Exceptions
Data
Element ID
O.
P.
Q.
R.
Data Element Description
The number of tiering exceptions.
The number of fully favorable decisions.
The number of partially favorable decisions.
The number of adverse decisions.
Subsection 2a: Redeterminations including exceptions and at-risk redeterminations)
Data
Data Element Description
Element ID
A.
Total Number of Redeterminations Processed (including exceptions and
at- risk)
Commented [CE46]: To be consistent with the rest of
the document, recommend adding “The total number of
Coverage Determinations (non-exceptions). Unless
that addition needs to go through PRA first. The same
for Subsection 2b.
Commented [SA47R46]: We are considering for 2027
Data
Data Element Description
Element ID
B.
Total Number of Withdrawn Redeterminations
C.
Total Number of Dismissed Redeterminations
Subsection 2b: Disposition – Redeterminations (non-exceptions)
Data
Element ID
D.
E.
F.
Data Element Description
The total number of fully favorable decisions.
The total number of partially favorable decisions.
The total number of adverse decisions.
Subsection 2c: Disposition – Utilization Management Exception Redeterminations
Data
Element ID
G.
H.
I.
J.
Data Element Description
The number of utilization management exceptions.
The number of fully favorable decisions.
The number of partially favorable decisions.
The number of adverse decisions.
Subsection 2d: Disposition – Formulary Exception Redeterminations
Data
Element ID
K.
L.
M.
N.
Data Element Description
The number of formulary exceptions.
The number of fully favorable decisions.
The number of partially favorable decisions.
The number of adverse decisions.
Subsection 2e: Disposition – Tiering Exception Redeterminations
Data
Element ID
O.
P.
Q.
R.
Data Element Description
The number of tiering exceptions.
The number of fully favorable decisions.
The number of partially favorable decisions.
The number of adverse decisions.
Subsection 2f: Disposition – At-Risk Redeterminations
Data
Element ID
S.
T.
U.
V.
Data Element Description
The number of at-risk exceptions.
The number of fully favorable decisions.
The number of partially favorable decisions.
The number of adverse decisions.
Commented [SA48]: Added per SME feedback
Subsection 3: Reopenings
Data
Data Element Description
Element ID
A.
The total number of reopened (revised) decisions, for any reason, in the
time period above.
B1.
Contract Number.
B2.
Case ID.
B3.
Case level (Coverage Determination or Redetermination).
B4.
Date of original disposition.
B5.
Original disposition (Fully Favorable, Partially Favorable, or Adverse)
B6.
Was case processed under expedited timeframe (Y/N)
B7.
Case type (Pre-service or Payment).
B8.
Date case was reopened
B9.
Reason(s) for reopening (Clerical Error, Other Error, New and Material
Evidence, Fraud or Similar Fault, or Other)
B10.
Date of reopening disposition (revised decision).
B11.
Reopening disposition (Fully Favorable, Partially Favorable, Adverse, or
Pending).
Commented [SS49]: Data elements have been moved
into a table instead of a list.
Commented [SS50]: For 2027, we are considering
removing Element A altogether.
Commented [SS51]: For 2027, these are our only
alpha numeric elements. We may change to A, B, C,
D…. For consistency with Part C reopenings.
Commented [SS52]: Information about file upload that
used to be in the second bullet of this list has been
moved to the TS as all info about file upload and data
entry is now in the Tech Specs.
Section VI. Employer/Union-Sponsored Group Health Plan Sponsors
The information requested is necessary for CMS to ensure that employer/unionsponsored group health plans that provide Part D benefits are properly utilizing waivers
and modifications in accordance with 42 CFR § 423.458(c). Additional information
regarding Part D plan waivers can be found in Chapter 12 of the Medicare Prescription
Drug Benefit Manual (https://www.cms.gov/regulations-andguidance/guidance/transmittals/downloads/dwnlds/r6pdbpdfpdf). ** (CMS regulations?)
stipulate specific parameters for MAOs offering employer group health and prescription
drug plans. The information requested is necessary for CMS to fulfill its affirmative
oversight obligation to ensure that plans with employer/union group health plan
enrollment that provide Part D benefits are properly utilizing these waivers and
modifications and that CMS’ statutory waiver authority is being implemented in
accordance with the requirements of section 1860D-22(b) of the Act.
Organization Types Required to
Report
-
Local CCP
MSA
RFB PFFS
PFFS
1876 Cost
PDP
Regional CCP
Employer/Union Only
Direct Contract PDPs
Employer/Union Only
Direct Contract PFFS
RFB Local CCP
Employer/Union Only Direct
Contract Local CCP
Organizations should include all
800 series plans and any individual
plans sold to employer groups.
Employer/Union Direct Contracts
should also report this reporting
section, regardless of organization
type.
Report
Frequency,
Level
Report
Period(s)
Data Due
Date(s)
1/year
1/1-12/31
(Rreporting at
annual level)
First Monday of
February of the
following year.
PBP level
Data Validation
not required.
Commented [SS53]: The title of this section has been
edited to reflect the title shown in HPMS an in Part C
documentation.
Reporting timeline:
Reporting Period
YTD
January 1 – December 31
Data due to CMS/HPMS
First Monday of February
1. Data file to be uploaded through the HPMS at the Plan (PBP) level:
Employer Legal Name.
Data
Element ID
Data Element Description
A.
Employer Legal Name
B.
Employer DBA Name
C.
Employer Federal Tax ID
D
Employer Address
E.
G.
Type of Group Sponsor (employer, union, trustees of a fund)
Organization Type (state government, local government, publicly
traded organization, privately held corporation, non-profit, church
group, other)
Type of Contract (insured, ASO, other)
H.
Is this a calendar year plan? (Y (yes) or N (no))
I.
If Edata element H is no“N", provide non-calendar year start date.
J.
Current/Anticipated enrollment
F.
Commented [SS54]: Duplicative of table above,
removing.
Commented [SS55]: These data elements have been
moved into a table rather that a list.
Section VII. Medicare Prescription Payment Plan
The “Medicare Prescription Payment Plan” was established by section 11202 of the
Inflation Reduction Act (IRA) of 2022 (P.L. 117-169). Section 1860D-2(b)(2)(E) of the
Social Security Act, as added by section 11202 of the IRA, requires all Medicare Part D
sponsors to offer their Part D enrollees the option to pay their out-of-pocket (OOP) Part
D drug costs through monthly payments over the course of the plan year instead of as
upfront payments at the pharmacy point of sale (POS), beginning January 1, 2025.
CMS does not expect Part D plans that exclusively charge $0 cost sharing for covered
Part D drugs to all plan enrollees to offer enrollees the option to pay their out-of-pocket
(OOP) costs through monthly payments over the course of the plan year or otherwise
comply with the requirements at 42 C.F.R § 423.137 and all applicable guidance,
including the Medicare Prescription Payment Plan reporting requirements. Plans that
exclusively charge $0 cost sharing for covered Part D drugs to all plan enrollees are
excluded from the Medicare Prescription Payment Plan reporting section. CMS collects
the data described below to assess the performance of Part D Sponsors with respect to the
Medicare Prescription Payment Plan. CMS’ oversight will help ensure financial stability, quality
healthcare services, including pharmacy benefits and regulatory compliance in the Medicare
Part D program, ultimately enhancing beneficiary satisfaction and program effectiveness.
Part D sponsors are responsible for reporting data elements related to their Medicare
Prescription Payment Plan offerings at the contract-Plan Benefit Package (PBP) levels.
CMS collects beneficiary-level data on the Medicare Prescription Payment Plan through
the Medicare Prescription Drug (MARx) System.
Reporting timeline:
YTD
January 1 – December 31
Last Monday of April
Reporting Period:
Data due to CMS/HPMS
Data file to be uploaded through the HPMS at the Plan (PBP) level:
Organization Types
Required to Report
Report
Frequency,
Level
Report
Period(s)
Data Due Date(s)
Commented [SS56]: Moved here from Part D TS.
Commented [SS57R56]: Updated with SME edits.
Commented [SS58]: Struck, as it is duplicative of PRA
materials and information in the introductory section of
this document.
Commented [SS59]: Struck as it is duplicative of the
table below.
Commented [SS60]: Struck as it is not really within
scope of a RR document. It is still TBD how we use the
RR and MARx data.
-
Local CCP
RFB PFFS)
PFFS)
1876 Cost
PDP
Regional CCP
Employer/Union Only
Direct Contract PDPs
- Employer/Union Only
Direct Contract PFFS
- RFB Local CCP
- Employer/Union Only
Direct Contract Local
CCP
Organizations should include
all 800 series plans.
Employer/Union Direct
Contracts should also report
this reporting section,
regardless of organization
type.
1/year
PBP level
1/1-12/31
(Rreporting at
annual level)
Last Monday of April
Data Validation not
required.
Likely to benefit identification:
Subsection 1: Likely to benefit identification
Data Element
ID
A.
B.
C.
D.
E.
Data Element Description
The total number of individuals identified as likely to benefit from the
Medicare Prescription Payment Plan during the reporting period
through any of the following methods: prior to plan year criteria;
during the plan year criteria; POS criteria (unique beneficiaries,
including those who did not elect to participate in the Medicare
Prescription Payment Plan).
The total number of individuals identified as likely to benefit from the
Medicare Prescription Payment Plan during the reporting period
based on prior to plan year criteria (unique beneficiaries, including
those who did not elect to participate in the Medicare Prescription
Payment Plan).
The total number of individuals identified as likely to benefit from the
Medicare Prescription Payment Plan during the reporting period
based on during the plan year criteria (unique beneficiaries, including
those who did not elect to participate in the Medicare Prescription
Payment Plan).
The total number of individuals identified as likely to benefit from the
Medicare Prescription Payment Plan during the reporting period
based on POS criteria (unique beneficiaries, including those who did
not elect to participate in the Medicare Prescription Payment Plan).
Among individuals identified in Eelement A, the total number of those
individuals who submitted an election request to participate in the
Medicare Prescription Payment Plan during the reporting period.
Subsection 2: Election request processing
Data Element
ID
F.
G.
H.
I.
J.
Data Element Description
The total number of Medicare Prescription Payment Plan election
requests received during the reporting period.
Of the total reported in Eelement F, the number of election requests
that were accepted during the reporting period.
Of the total reported in Eelement F, the number of election requests
that were not complete at the time of initial receipt and for which the
sponsor was required to request additional information from the
applicant (or his/her representative).
Of the total reported in Eelement H, the number of election requests
received that were able to be completed within established
timeframes.
Of the total reported in Eelement H, the number of election requests
denied due to the applicant or his/her authorized legal representative
Commented [SS61]: These data elements have been
moved into a table rather that a list. No other changes
were made to the elements.
Data Element
ID
K.
Data Element Description
not providing the information required to complete the election
request within established timeframes.
Of the total reported in Eelement F, the number of election requests
that were denied during the reporting period.
Election request processing:
Subsection 3: Unsettled balances
Data Element
ID
L.
M.
N.
O.
Data Element Description
The collected Medicare Prescription Payment Plan amounts from the
reporting period.
The uncollected Medicare Prescription Payment Plan balances from
the reporting period.
Number of program participants with uncollected Medicare
Prescription Payment Plan balances from the reporting period.
Number of individuals precluded from opting into the Medicare
Prescription Payment Plan (in the subsequent year).
Unsettled balances:
| File Type | application/pdf |
| File Title | Part D Plan Reporting Requirements_Redline |
| Author | CMS |
| File Modified | 2025-09-18 |
| File Created | 2025-09-18 |