Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Payment Elements Form

Medicare Transaction Facilitator for 2026 and 2027 under Sections 11001 and 11002 of the Inflation Reduction Act (IRA) (CMS-10912)

OMB:

IC ID: 274427

Documents and Forms

Document Name Document Type
Form CMS-10912 Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Payment Elements Form Form and Instruction
CMS-10912 MTF DM Primary Manufacturer Payment Elements 2025.03.10_MTF_ICR_ManufacturerPaymentElementsForm_clean_v3.docx Form and Instruction
2025_03_10MTF_ICR_MFRPaymentElementsForm_trackchanges.pdf Track Change - MFRPaymentElementsForm IC Document