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SAS Name
BENEFIT_PHASE
This is a CCW-derived field that indicates the benefit phase in which the prescription likely occurred. This is done by ordering the beneficiary's claims by their dates of service and then comparing the cost of those PDEs to the benefit structure for the beneficiary’s plan.
The benefit phase is described using a two-digit code. The first digit indicates the benefit phase immediately before the prescription was filled, and the second digit indicates the benefit phase immediately after the prescription was filled. The two digits are necessary because the benefit phases depend on specific dollar amounts and often do not split exactly between prescription fills; that is, a particular PDE may “straddle” more than one benefit phase. For example, “DD” indicates that the beneficiary was in the deductible phase of the benefit both before and after filling the prescription, but “PI” indicates that this PDE occurred partly in the pre-ICL phase and partly in the coverage gap.
Source: PDE (derived)
| Code | Code value |
|---|---|
| Null/blank | Not a covered drug |
| CC | PDE occurred in catastrophic phase |
| DC | PDE straddled deductible and catastrophic phases |
| DD | PDE occurred in deductible phase |
| DI | PDE straddled deductible and ICL (coverage gap) phases |
| DP | PDE straddled deductible and pre-ICL phases |
| IC | PDE straddled ICL (coverage gap) and catastrophic phases |
| II | PDE occurred in ICL (coverage gap) phase |
| NA | Beneficiary enrolled in PACE or employer-sponsored plan |
| PC | PDE straddled pre-ICL and catastrophic straddle phases |
| PI | PDE straddled pre-ICL and ICL (coverage gap) phases |
| PP | PDE occurred in pre-ICL phase |
| XX | PDE plan identifiers do not link to the plan benefit file |
Some non-standard combinations of benefit phases might appear, particularly if a beneficiary changed plans during the year.
The CCW creates this variable based on the beneficiary’s plan benefit package at the time of the prescription was filled (using the Part D contract and plan of record which appear in the CCW Master Beneficiary Summary A/B/D file). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be accurate.