Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information
Principal Investigator(s): View help for Principal Investigator(s) Centers for Medicare & Medicaid Services
Version: View help for Version V1
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Project Citation:
Project Description
- Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
- Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
- Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, prior authorization, and a newly added Selected Drug flag.
- Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
- Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
- Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators, and brand, generic, and selected drug dispensing fees for 30/60/90 days supply, respectively.
- Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).
- Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
- Insulin Beneficiary Cost File - Plan level copay and coinsurance amounts for insulin at preferred, non-preferred and mail order network pharmacies.
Scope of Project
Related Publications
Published Versions
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