Formulary Guidance
This page provides important information on prescription drug coverage policies under Medicare, the framework for CMS' review of Medicare prescription drug plan formularies, and instructions concerning formulary file uploads.
Click the selection that best matches your informational needs. Please check back as we will continue to update these resources regularly.
Please note that Transition related documents have been move to the "Part D Transition" page - click the link in "Links within CMS" to access the page.
Downloads
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2025 Pricing Data Guidelines and Calendar (ZIP) -
2024 Pricing Data Guidelines and Calendar (v 07 07 23) (ZIP) -
2020-2023 Pricing Data Guidelines and Calendar (ZIP) -
HPMS Memo: Medical Supplies Associated with the Injection of Insulin (v 01 05 2018) (PDF) -
CY 2025 July Formulary Reference File (ZIP) -
CY 2024 September Formulary Reference File (ZIP) -
Formulary Reference File Archive (ZIP) -
Formulary Reference File FAQ (ZIP) -
CY 2023 OTC Reference File (ZIP) -
OTC Reference File FAQ (ZIP) -
CY 2023 Excluded Drug Reference File (ZIP) -
Excluded Drug Reference File FAQ (ZIP)