Updated research request forms and data security approval required beginning 4/24/23
This variable is contained in the following files:
This is a CCW-derived field that indicates whether the prescription was subject to quantity limits, according to the benefit structure and formulary for the beneficiary’s plan.
Starting in 2010, this variable is included in the Formulary file (rather than the PDE file).
|1||Quantity limits apply|
|0||Quantity limits do not apply|
Part D plan sponsors submit the pricing, tiers, and formularies for their plan benefit packages to CMS via the Health Plan Management System (HPMS).
This includes information on which drugs are subject to quantity limits, which restrict the amount that a beneficiary may receive within a certain time period.
The CCW creates this variable based on the beneficiary’s plan of record, which is identified using the Part D contract and plan benefit package of record (the PLAN_CNTRCT_REC_ID and PLAN_PBP_REC_NUM variables). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be an accurate reflection of whether the PDE was subject to quantity limits.
Source: PDE and Plan Characteristics (derived)