Welcome to the health plan management system also known as HPMS. HPMS is a
secure internet accessible information system maintained by the Centers for
Medicare and Medicaid Services. Over 60 HPMS software modules support the
business operations of the Medicare Advantage, MA and prescription drug Part
D programs. Through these automated solutions CMS strives to streamline
business transactions for our private partners, as we work together to provide
Medicare beneficiaries with a diverse set of high-quality health care options.
Welcome to the Formulary Submission module in the Health Plan Management
System HPMS. We will demonstrate how to submit a
formulary and supplemental files in HPMS. Please be advised that any
information disclosed or discussed during this training will not modify or
supersede any regulations, manual provisions, or other written guidance
issued by the Centers for Medicare and Medicaid Services CMS. The Formulary
Submission module in HPMS enables Part D plans to submit formulary files for a
contract that contains all or a subset of drugs using the CMS provided
formulary reference file FRF. The formulary submission module can be
accessed within the plan formulary section on the HPMS primary navigation
bar The formulary submission process contains a series of web pages that will
collect information from the plan organization. Please note that prior to
beginning the formulary submission process you must ensure that the
formulary contact information in the contract management module in HPMS is
completed. This video is a brief demonstration. For information and
troubleshooting assistance refer to the formulary instructions available under
the documentation section. Accurate formulary submissions are
essential. Formulary submissions are based on RXCUIs. Only RXCUIs
listed in the FRF will be considered valid submission codes. The FRF and the
detailed layouts of all the submission files are available under the
documentation section. Select the formulary submission menu item which
takes you to the formulary submission start page. Select the appropriate
contract year from the collapsible navigation menu. Select submission file
layouts link under documentation. It is imperative that the files you are
uploading be in the following format. For the formulary file, prior authorization
file, and step therapy file, use the ASCII tab delimited text file format. During
the initial submission period the value of change underscore type field must be
ADD all records in the file. Quality assurance checks on the initial
formulary submissions must be performed to prevent errors from occurring. To
submit a new formulary file, select the plan formularies drop-down from the HPMS
top navigation bar, then select the formulary submission menu item, which
takes you to the formulary submission start page. Select the appropriate
contract year from the collapsible navigation menu. Select submit new
formulary from the formulary submission start page.
On the formulary plan type indicate whether you are Medicare Medicaid plan
and select next to go to the associate contracts to the formulary. Select one or
more of the contracts listed on the associate contracts to formulary page to
associate with the new formulary. Select next to go to the formulary information
page. The formulary information page collects information about your
formulary submission. If you have a previous year formulary ID that you want
to closely resemble, select it from the drop down if available otherwise leave
this field empty as it is optional. Enter your formulary name
indicate the formulary classification system
to find the number of tiers. Select yes or no for the following
Provide OTC as part of step therapy protocol status, quantity limit status,
limited access status, prior authorization status, and step therapy status.
Select next to go to the formulary tier information page. On the
formulary tier information page, select the number of tiers within the formulary
tier model and then select next to go to the formulary submission upload files
page. The formulary submission uploads files page allows you to specify the
formulary file prior authorization file and step therapy file you want to upload.
During the initial submission submit a full formulary file and full prior
authorization step therapy files if applicable. Select upload button to go to
the verify submission page. On the verify submission page verify the information
you entered during the submission process. Once verified, select the submit
button to go to the submission confirmation page.
The submission confirmation page confirms successful receipt of your submission
and provides the unique formulary ID assigned to your submission. This page
will also generate an email to all formulary contacts and the formulary
upload contact identified on this page acknowledging receipt of the submission
and the assigned formulary ID. After receiving your submission HPMS will
perform a series of validation edits. At the close of the validation process a
follow-up email will be sent to the designated formulary contacts. This email
will indicate that the formulary was successfully validated or identify
errors detected during the validation process. If errors were detected, the
formulary submission will be rejected. These emails are also available in the
formulary status history report. To check the status of the formulary
submitted select the plan formularies drop-down from the HPMS top navigation
bar then select the formula reports menu item. This will take you to the formulary
reports page. On the formulary reports page select the appropriate contract
year from the collapsible navigation menu on the right side of the page. This
takes you to the report selection page. The formulary reports module provides
various reports related to formularies submitted.
Select the formulary status history report on the report selection page and
then select next. Select the formulary ID on the formulary status history report
parameter page and select next to go to the report. The formulary status history
report provides detailed status information about all versions for a
given formulary ID. The report also provides access to the email sent out
from HPMS. To view the email sent regarding the formulary and PA ST file
upload, select link provided under the formulary status link.
As part of the formulary submission process, you are required to submit
certain supplemental files depending on what is included in your bid.
Organizations must submit supplemental information for all the plans offering
this coverage. The supplemental files cannot be loaded until the organization
has successfully submitted its related bids and the bid has migrated into desk
review in the HPMS system. Once this has occurred the required supplemental
file gates will automatically open for submission of the required files. Only
one supplemental file version may be submitted for each file type per formulary.
However, it is not required that all plans associated with the specific
formulary offer supplemental coverage. As mentioned earlier the detailed layouts
of all these submission files are available under the documentation
section, which can be accessed from the formulary submission page. The video
provides an example of uploading one supplemental file the Free First Fill.
Select submit Free First Fill File from the formulary submission page. This takes
you to the Free First Fill supplemental files select a formulary page. The Free
First Fill supplemental file select a formulary page contains a list of all
formularies that require a Free First Fill File. Note that only one formulary
can be selected at a time. Select a formulary for which to upload a Free
First Fill File and select next. This takes you to the Free First Fill supplemental
files upload supplemental file page. Please note that only those plans with
bid submissions that offer this benefit will be displayed. Plans that are linked
to this formulary but do not offer this benefit will not be displayed as the
supplemental file submission is not applicable to them. Enter the name of the
Free First Fill supplemental .txt file you wish to upload, and select the
upload button to go to the Free First Fill supplemental file verify page. On
the Free First Fill supplemental file verify page, select the submit button to
go to the Free First Fill supplemental file submission confirmation page. Select
ok button to confirm submission. While the instructions demonstrate how to
submit the Free First Fill File, you can also use these instructions to upload
the additional demonstration drug, partial gap coverage, home infusion,
value-based insurance design, excluded drug, and over-the-counter files. The
steps taken to upload files are the same for each supplemental file type. The
status history report Free First Fill under formulary reports provides
detailed status information and displays the email sent for all submissions for a
given formulary ID or contract ID. For more information on HPMS please
visit our public website page. You can also contact the HPMS help desk at
either HPMS@CMS.HHS.gov or 1-800 220-2028. Thank
you for taking the time to learn about the Health Plan Management System. Please
check back here for additional videos on HPMS functionality. Brought to you by
the CMS Center for Medicare, Medicare Drug Benefit and C and D Data Group,
Division of Plan Data.