CMS Plan Benefit Package (PBP) and Formulary CY 2027 (CMS-R-262) - IRA

CMS has incorporated the following changes to address the Inflation Reduction Act (IRA). This includes new attestations and data entry fields to reflect Part D policy changes (i.e., new insulin and vaccine benefits and $0 cost sharing in the catastrophic phase) that are required by the IRA, specifically Sections 11101, 11201, 11401, and 11406. CMS is also modernizing the PBP software by migrating from its current client/server based platform to a new web-based module within HPMS. This initiative is critical, as the current platform technically antiquated. The new PBP module will enhance system security, improve the user interface, streamline the bid submission process, increase system performance, and provide greater flexibility to accommodate unique benefit designs. CMS requires that MA and PDP organizations submit a completed formulary and PBP 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.

The latest form for CMS Plan Benefit Package (PBP) and Formulary CY 2027 (CMS-R-262) - IRA expires 2027-03-31 and can be found here.