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SAS Name
POST_OOPT_APPLY
IThis variable indicates how the plan applies beneficiary cost-sharing once the beneficiary has reached the Medicare-defined Part D annual Out-of-Pocket (OOP) Cost Threshold (i.e., in catastrophic coverage phase).
| Code | Code value |
|---|---|
| 1 | Medicare-Defined Post Threshold Cost Shares |
| 2 | Cost Share Tiers |
| 3 | No Cost sharing |
For Fixed Capitated Reinsurance Demonstration Projects, this variable captures how cost sharing is applied after the Medicare-defined total drug spending amount. The CCW constructs the Plan Characteristics File from information submitted by Part D plan sponsors to CMS's Health 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.