Gap Mail Order Pharmacy Coinsurance for other days supply
SAS Name
GAP_MO_COINS_OS
This variable identifies the beneficiary co-insurance percentage for a days supply of the drugs (other than 1 or 3 months) on this tier, using a mail order pharmacy during the coverage gap phase of the Part D benefit.
Comments
This variable was only populated from 2007 - 2012. It will only be populated if the plan has an enhanced benefit design with extra coverage in the gap. The coverage gap is technically referred to as the initial coverage limit (ICL) for the Part D benefit. Plans that use a co-payment amount rather than a coinsurance percentage will not have a value in this field; see instead the corresponding co-payment variable called (GAP_MO_COPAY_OS). The CCW constructs the Plan Characteristics File from information submitted by Part D plan sponsors to CMS’sHealth Plan Management System (HPMS). Employer and National Program of All-inclusive Care for the Elderly (PACE) plans are waived from reporting Plan Benefit Package information. For those plans that did not report, the value of this variable will be blank.
This variable was only populated from 2007 - 2012. It will only be populated if the plan has an enhanced benefit design with extra coverage in the gap. The coverage gap is technically referred to as the initial coverage limit (ICL) for the Part D benefit. Plans that use a co-payment amount rather than a coinsurance percentage will not have a value in this field; see instead the corresponding co-payment variable called (GAP_MO_COPAY_OS). The CCW constructs the Plan Characteristics File from information submitted by Part D plan sponsors to CMS’sHealth Plan Management System (HPMS). Employer and National Program of All-inclusive Care for the Elderly (PACE) plans are waived from reporting Plan Benefit Package information. For those plans that did not report, the value of this variable will be blank.