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.
Comments
For 2006–2009 this variable was found in the Event Characteristics files (BP_UM_TIER_YYYY_MM).This variable is first available in the Formulary file in 2010.
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 value of this field may not exactly represent the beneficiary experience at the time of the prescription fill (e.g., no data are collected at the time of the transaction to indicate the actual beneficiary experience).
For 2006–2009 this variable was found in the Event Characteristics files (BP_UM_TIER_YYYY_MM).This variable is first available in the Formulary file in 2010.
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 value of this field may not exactly represent the beneficiary experience at the time of the prescription fill (e.g., no data are collected at the time of the transaction to indicate the actual beneficiary experience).
Source: CMS (HPMS Files)