CY 2026 Pharmacy Cost File Alternative Layout Guide
Relevant to: PDP, 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.
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Read the complete details of the CY 2026 Pharmacy Cost File Alternative Layout
Introduction
The Appendix E for CY 2026 outlines an alternative layout for the Pharmacy Cost File, specifically for Part D sponsors choosing to implement distinct dispensing fees for particular drugs. This file requires key identifiers such as CONTRACT_ID, PLAN_ID, SEGMENT_ID, and PHARMACY_NUMBER, ensuring each entry is unique. Additionally, various fields detail fees for different drug supply days and network pharmacy statuses, providing precise instructions for their inclusion within the record.
Key Dates and Deadlines
- Date: May 27, 2025
PACE Compliance
This document pertains to the alternative layout for the CY 2026 Pharmacy Cost File used by Part D sponsors. It is specifically relevant to PACE programs that may opt to establish different dispensing fees for selected drugs. The memo outlines the necessary data fields and their specifications, which must be adhered to for compliance with CMS requirements. It discusses various fields such as CONTRACT_ID, PLAN_ID, SEGMENT_ID, and PHARMACY_NUMBER, which are unique record identifiers.
PACE compliance necessitates that:
Plans use the alternative layout when different dispensing fees are established for selected drugs by Part D sponsors.
All necessary fields such as selected drug dispensing fee fields must be included, indicating compliance with required data submission formats.
Dispensing fees for brand and generic drugs, as well as selected drugs, must adhere to specified currency formats and descriptions, ensuring accuracy in reporting.
Overall, adherence to these details ensures that PACE plans maintain compliance with CMS guidelines and facilitate accurate data reporting and proper pharmacy reimbursement processes. Non-compliance in aligning with these guidelines may lead to issues in claim processing and reimbursement schedules.
Read the complete details of the CY 2026 Pharmacy Cost File Alternative Layout
