Part D Beneficiary Payments

SAS Name

This variable is the dollar amount that the beneficiary paid for all PDEs for a given year, without being reimbursed by a third party. The amount includes all copayments, coinsurance, deductible, or other patient payment amounts, and comes directly from the source Prescription Drug Events (PDEs).

The total beneficiary payments are calculated as the sum of three CCW variables: patient pay amount (PTNT_PAY_AMT), other troop amount (OTHER_TROOP_AMT), and patient liability reduction due to other payer amount (PLRO_AMT) for Part D drugs for the relevant PDEs.


This amount contributes to a beneficiary's true out-of-pocket (TrOOP) costs, but only if it is for a Part D- covered drug (i.e., spending on non-covered drugs does not count toward the TrOOP amount).

Note that another PDE variable called the low-income cost sharing (LIS) amount (variable name LICS_AMT), indicates the amount paid by Part D low-income subsidy for the PDE. Although this is sometimes considered a beneficiary payment (since it is made on behalf of a beneficiary), we have included the LIS payments in the Part D Medicare Payment amount (see variable called PTD_MDCR_PMT).

The value will be null if the beneficiary was not enrolled in Part D or did not use any Part D drugs during the year.

Source: CCW (derived)