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This variable identifies what types of drugs, if any, are covered in formulary tier 1 through 6 during the coverage gap phase. The value contains a string of binary digits; each digit of the value indicates which types of drugs are covered on this tier of the formulary. A tier may include multiple drug types.
| Code | Code value |
|---|---|
| 1 in 1 | Non-Preferred Brand |
| 1 in 2 | Generic |
| 1 in 3 | Preferred Generic |
| 1 in 4 | Non-Preferred Generic |
| 1 in 5 | Brand |
| 1 in 6 | Preferred Brand |
This variable was new in 2007. There are a different number of the variables each year to describe tiers, due to variation in the formulary tiers over time. See GAP_DRUG_TYPE_TIER_01 - GAP_DRUG_TYPE_TIER_09. During 2008 - 2010 there were seven tiers (i.e., variables called GAP_DRUG_TYPE_TIER_08 and GAP_DRUG_TYPE_TIER_09 did not apply). For 2011 and later, there were only six tiers (i.e., variable called GAP_DRUG_TYPE_TIER_07 was not applicable after 2010). The coverage gap is technically referred to as the initial coverage limit (ICL) for the Part D benefit. CMS Chronic Conditions Data Warehouse (CCW) – Codebook Medicare Part D Plan Characteristics File Version 1.0 (May 2017) Page 95 of 444 The CCW constructs the Plan Characteristics File from information submitted by Part D plan sponsors to CMS’s Health Plan Management System (HPMS).