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SAS Name
OTHR_TROOP_AMOUNT_IND
This code is used when the Other TrOOP Amount (variable called OTHR_TROOP_AMOUNT) includes Inflation Reduction Act Subsidy Amount (IRASA) dollars for benefit year 2023.
Source: PDE
| Code | Code value |
|---|---|
| B | the amount reported in Other TrOOP field contains both IRASA and non-IRASA Other TrOOP amounts |
| S | the amount reported in Other TrOOP contains only IRASA Other TrOOP amount |
| Null/missing | Not applicable. The amount reported in Other TrOOP contains only non-IRASA Other TrOOP amount, if any. |
Effective January 1, 2023, the Inflation Reduction Act (IRA) eliminates the deductible and imposes a statutory maximum beneficiary cost sharing of $35 per month’s supply for Part D covered insulins. In addition, effective January 1, 2023, the IRA eliminates the deductible and imposes a statutory maximum beneficiary cost sharing of $0 for adult vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP).
CMS defines IRASA as the difference between the beneficiary cost sharing for the covered insulin, or ACIP-recommended vaccine, under the plan’s 2023 benefit design, and the applicable statutory maximum cost sharing ($35 for insulins and $0 for vaccines). The IRASA is available only for 2023. Additional details are available from CMS (reference): https://www.cms.gov/files/document/irasapdeguidance508g.pdf).