2026 Ceiling Price File Layout Guide for Organizations
Relevant to: Drug Pricing, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
Disclaimer: The content provided on this site is a summary for informational purposes only, and Grane PBM, Inc. assumes no liability for any errors or omissions in the site’s content. The information does not constitute legal or regulatory advice or replace the original CMS memo. Readers are advised to consult the CMS memo in its entirety and to verify information independently before making any decisions based on this information.
Click here for the full CY 2026 Ceiling Price File Layout details.
Introduction
The Appendix G CY 2026 Ceiling Price File Layout outlines crucial details for managing drug costs in Medicare plans. This file includes unique record identifiers such as CONTRACT_ID and PRICE_ID, along with critical fields like NDC, DAYS_SUPPLY, and CEILING_QTY. The specifications provide guidance on accounting for both retail and mail order dispensing scenarios, ensuring accurate cost management in line with CMS standards.
Key Dates and Deadlines
- Data as of: May 27, 2025
- Implementation Year: CY 2026
PACE Compliance
This memo is relevant to PACE programs because it outlines the layout and requirements for submitting the Ceiling Price File for CY 2026. Compliance with these guidelines is critical for maintaining and submitting accurate pricing data.
Plans must ensure the following for PACE compliance:
1. Use the unique record identifiers properly: CONTRACT_ID, PRICE_ID, NDC, DAYS_SUPPLY, IS_MAIL, and CEILING_QTY. Each record must be accurately associated with the organization’s contract number and the correct drug representation.
2. Include the correct National Drug Code (NDC), ensuring it is the approved 11-digit code from the formulary.
3. Specify the DAYS_SUPPLY using the acceptable values of 30, 60, or 90 to ensure consistency across submissions.
4. Precisely define IS_MAIL with accepted values (0 for retail costs and 1 for mail order costs), ensuring clarity on how costs apply to dispensing locations.
5. Accurately input the CEILING_QTY and CEILING_COST with appropriate formats and defaults as necessary. Use ‘000000’ or ‘000000000000’ when ceiling quantity or cost is not applicable.
Failure to comply with these detailed data requirements may lead to non-compliant submissions, which could impact participation in PACE programs.
Required Actions
The provided content explains the layout of a Ceiling Price File for CY 2026. Here are the actions you need to take:
1. Ensure all fields, such as CONTRACT_ID, PRICE_ID, NDC, DAYS_SUPPLY, and others are correctly filled out as per their respective requirements and formats.
2. Verify that the IS_MAIL and CEILING_QTY are set with the correct default values and formats if they are not applicable.
3. Confirm that the CEILING_COST is entered with the proper currency format as specified, ensuring accuracy in the data.
FAQs
- “What is the Ceiling Price File Layout for CY 2026?”
- “How is the CONTRACT_ID used in the Ceiling Price File?”
- “What does the PRICE_ID represent in the ceiling cost data?”
- “How should the NDC be formatted in the Ceiling Price File?”
- “What are the acceptable values for DAYS_SUPPLY in the Ceiling Price File?”
Click here for the full CY 2026 Ceiling Price File Layout details.
