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Indicates whether or not the Part D plan pays for Over-the-Counter medications (OTCs) under the Utilization Management Program.
This variable is the date the Part D plan sponsor began offering the particular plan benefit package.
Indicator representing the iteration of the file.
Indicates whether or not the Part D plan offers free generic drugs.
Indicates reduced cost sharing applies to the Initial Coverage Limit by offering an ICL that is higher than the year's predefined standard ICL amount.
Indicates whether or not this Part D plan offers limited benefits above the initial coverage limit. This benefit is not considered Gap coverage.
Indicates whether or not beneficiaries enrolled in this Part D plan are able to purchase drugs in all 50 states.
This variable indicates whether the plan offers reduced Part D cost-sharing as part of its supplemental Part D benefit.
This variable indicates whether the plan offers reduced cost sharing in the deductible phase of the Part D benefit.
This variable indicates whether the plan offers reduced cost sharing in the post out-of-pocket threshold (catastrophic) phase of the Part D benefit.
This variable indicates whether the plan offers reduced cost sharing applies to the pre-Initial Covearge Limit (ICL) phase of the Part D benefit.
This variable is the name of the plan sponsor's marketing name for the organization.
This variable is the name of the parent organization for the plan, if applicable.
Indicates whether or not the Part D plan limits access to any drugs to certain specialty pharmacies.
This variable indicates the type of plan offered by the plan sponsor.
Indicates whether the provider’s taxonomy value maps to the podiatric medicine and surgery services provider category; ever in the calendar year.
This variable identifies the co-insurance percentage that drugs on the tier are subject to during the post out-of-pocket threshold (catastrophic) phase of the Part D benefit.
This variable identifies the beneficiary copay amount that drugs on the tier are subject to during the post out-of-pocket threshold (catastrophic) phase of the Part D benefit.
This variable identifies the type of cost sharing that drugs on the tier are subject to for each formulary tier during the post-out-of-pocket threshold phase (also known as the catastrophic coverage phase). Cost-sharing may include copayment, co- insurance, or the greater/lesser of the two.
This variable identifies what types of drugs, if any, are covered on each formulary tier during the post-out-of-pocket threshold phase (also known as the catastrophic coverage phase). A tier may include multiple drug types.
This variable indicates whether a beneficiary met the condition criteria for posttraumatic stress disorder as of the end of the calendar year.
This variable shows the date when the beneficiary first met the criteria for the posttraumatic stress disorder indicator. The variable will be blank for beneficiaries that have never had the condition.
Practice group type.
Indicator denoting if this is a practice location address type for the provider.
Practice's address (line 1).
Practice's address (line 2).
Practice's billing federal Taxpayer Identification Number (TIN).
Practice's city.
Practice's state (postal abbreviation).
Practice's federal Taxpayer Identification Number (TIN).
Practice's zip code.
Practitioner first name
Practitioner last name.
Practitioner's accuracy of attestation. This variable addresses the question, “Has the practitioner attested to accuracy?”
Practitioner's attestation to follow-up. This variable addresses the question, “Has the practitioner attested to follow-up?"
Prostate Cancer - Medicaid Only Claims, First Ever Occurrence Date
Prostate Cancer - Medicare Only Claims, First Ever Occurrence Date
A number, code, or other value that indicates the services provided on this claim have been authorized by the payee or other service organization, or that a referral for services has been approved. (Also called Prior Authorization or Referral Number).
This variable identifies the average expected cost-sharing amount in dollars for beneficiary co-insurance for a 1 month supply of the drugs on this tier, using an in-network preferred pharmacy (INPP; also known as a preferred pharmacy within a split network) during the pre-initial coverage limit (ICL) phase of the Part D benefit.
This variable identifies the average expected cost-sharing amount in dollars for beneficiary co-insurance for a 1 month supply of the drugs on this tier, using an innetwork non-preferred preferred pharmacy (INNPP; also known as a standard retail pharmacy within a split network) during the pre-initial coverage limit (ICL) phase of the Part D benefit.
This variable identifies the average expected cost-sharing amount in dollars for beneficiary co-insurance for a 1 month supply of the drugs on this tier, using an in-network pharmacy (INP; also known as a standard retail pharmacy) during the pre-initial coverage limit (ICL) phase of the Part D benefit.
Pre-initial coverage limit: in-network pharmacy co-insurance percentage for 1 month supply.
Pre-initial coverage limit: in-network preferred pharmacy co-insurance percentage for 1 month supply.
Pre-initial coverage limit: in-network preferred pharmacy co-insurance percentage for other supply.
Pre-initial coverage limit: in-network preferred pharmacy co-insurance percentage for 3 month supply.
This variable identifies the beneficiary co-insurance percentage for a 3 month supply of the drugs on this tier, using an in-network preferred pharmacy (INPP) during the pre-initial coverage limit (ICL) phase of the Part D benefit.
This variable identifies the beneficiary co-insurance percentage for a days supply of the drugs (other than 1 or 3 months) of the drugs on this tier, using an in-network preferred pharmacy (INPP) during the pre-initial coverage limit (ICL) phase of the Part D benefit.
Pre-initial coverage limit: out-of-network pharmacy co-insurance percentage for 1 month supply.
Pre-initial coverage limit: out-of-network pharmacy co-insurance percentage for other supply.
This variable identifies the beneficiary co-insurance percentage for a 1 month supply of the drugs on this tier, using an in-network preferred pharmacy (INPP; also known as a preferred pharmacy within a split network) during the pre-initial coverage limit (ICL) phase of the Part D benefit.