Gap In-network Pharmacy 1 month Copay for Tiers 1 - 6
This variable identifies the dollar amount of the beneficiary copayment for a 1 month supply of the drugs on this Tiers 1 through 6, using an in-network pharmacy during the coverage gap phase of the Part D benefit. Applies only to enhanced plans with gap coverage.
Comments
This variable was new in 2007. It changed from 12 digits to 8 in 2009. There are a different number of the variables each year to describe tiers, due to variation in the formulary tiers over time. There are different variables to describe all possible tiers in the coverage gap benefit phase. See also GAP_INP_1M_COPAY_TIER_01 - GAP_INP_1M_COPAY_TIER_09. During 2008- 2010 there were only seven tiers (i.e., variables GAP_INP_1M_COPAY_TIER_08 and GAP_INP_1M_COPAY_TIER_09 were not applicable). For 2011 and later, there were only six tiers (i.e., variable called GAP_INP_1M_COPAY_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. The CCW constructs the Plan Characteristics File from information submitted by Part D plan sponsors to CMS’s Health Plan Management System (HPMS).
This variable was new in 2007. It changed from 12 digits to 8 in 2009. There are a different number of the variables each year to describe tiers, due to variation in the formulary tiers over time. There are different variables to describe all possible tiers in the coverage gap benefit phase. See also GAP_INP_1M_COPAY_TIER_01 - GAP_INP_1M_COPAY_TIER_09. During 2008- 2010 there were only seven tiers (i.e., variables GAP_INP_1M_COPAY_TIER_08 and GAP_INP_1M_COPAY_TIER_09 were not applicable). For 2011 and later, there were only six tiers (i.e., variable called GAP_INP_1M_COPAY_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. The CCW constructs the Plan Characteristics File from information submitted by Part D plan sponsors to CMS’s Health Plan Management System (HPMS).