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