Copay

SAS Name
COPAY

This variable identifies the beneficiary copayment amount for the drug products covered by the Part D Senior Savings (PDSS) model. The insulin drug products (represented by the FRMLRY_RX_ID) covered as part of the PDSS have a different payment structure than other insulins (or other drug products) on the formulary.

Values: up to 3-digit numeric value

Source: CMS (HPMS files)

Comments

The PDSS Model file was new in 2021. Additional details regarding this CMS Innovation Center Model are available on the CMS website.