US · guidance
CMS Pub. 100-18, ch. 7, § 60.5
Website Posting Requirements
Part D sponsors must post their approved PA criteria (including PA criteria applied to
supplemental drugs provided by enhanced alternative plans), quantity limit restrictions and step
therapy requirements on plan Web sites. Given the uniformity that results from utilization of a
standardized HPMS submission form during formulary review, CMS believes that Web page
posting of this information will augment the Part D sponsor’s ability to rapidly provide this
information, improve transparency and allow Part D plan comparison during enrollment. Part D
sponsors will need to ensure that all approved utilization management (UM) criteria are posted
on Part D sponsor Web sites in the formulary section by November 15 each year. CMS expects
Part D sponsors to make these criteria available for beneficiary viewing either from a link when
the drug identified with UM is displayed or from a general link on the formulary page. Part D
sponsors will be expected to display all of the UM criteria content contained within the CMS
approved HPMS files without modification. Minor grammatical changes will be permitted for
display purposes in cases where abbreviations or grammatical errors occurred due to HPMS file
character limitations.
History
(Rev. 11, Issued: 02-19-10, Effective/Implementation Date: 03-01-10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
6352b9bf11f2876d47134d3520f990c34a35edd4650f3853261fb75a2615db8c
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