OMB control number
Pharmacy Billing Requirements
OMB 1240-0050 · DOL/OWCP.
OMB 1240-0050
The National Council for Prescription Drug Programs standardized pharmacy billing data requirements are the electronic billing format used by pharmacies throughout the country to request payment for prescription drugs through data clearinghouses. They identify the provider, claimant, prescribing physician, drug by National Drug Code number, prescription volume and charge. Similar data elements are required to process paper-based pharmacy bills.
The latest form for Pharmacy Billing Requirements expires 2028-08-31 and can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
|---|
Supporting Statement A |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
1240-0050 Pharmacy Billing Requirements 2025 7 28.docx
Instructions for Required Data Elements for Pharmacy Bills.pdf
Pharmacy Billing Requirements All Historical Document Collections
| Extension without change of a currently approved collection | 2025-07-28 | ||
|
Approved without change |
Extension without change of a currently approved collection | 2022-08-23 | |
|
Approved without change |
Extension without change of a currently approved collection | 2019-07-11 | |
|
Approved without change |
Revision of a currently approved collection | 2019-02-13 | |
|
Approved without change |
Extension without change of a currently approved collection | 2016-01-29 | |
|
Comment filed on proposed rule and continue |
Revision of a currently approved collection | 2015-11-18 | |
|
Approved without change |
Extension without change of a currently approved collection | 2012-12-19 | |
|
Approved without change |
Extension without change of a currently approved collection | 2010-03-26 |