This is a CCW-derived field that indicates whether the prescription was subject to a step therapy protocol, according to the benefit structure and formulary for the beneficiary’s plan.
Source: CMS (HPMS Files)
Comments
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 step therapy, which requires a beneficiary to first try one or more other medications in the same therapeutic class. 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).
This variable is first available in the Formulary Excluded Drug file in 2012.
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 step therapy, which requires a beneficiary to first try one or more other medications in the same therapeutic class. 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).
This variable is first available in the Formulary Excluded Drug file in 2012.