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Coverage gap: out-of-network pharmacy number of days in 1 month supply. Note, this field can only be populated if the plan has an enhanced benefit design with extra coverage in the gap.
Coverage gap: out-of-network pharmacy number of days in other supply. Note, this field can only be populated if the plan has an enhanced benefit design with extra coverage in the gap.
This variable identifies the beneficiary co-insurance percentage for a 1 month supply of the drugs on this tier, using an out-of-network pharmacy (OONP) during the coverage gap phase of the Part D benefit.
This variable identifies the beneficiary co-insurance percentage for a days supply of the drugs (other than 1 month) on this tier, using an out-of-network pharmacy (OONP) during the coverage gap phase of the Part D benefit.
This variable identifies the beneficiary co-payment amount for a 1 month supply of the drugs on this tier, using an out-of-network pharmacy (OONP) during the coverage gap phase of the Part D benefit.
This variable identifies the beneficiary co-payment amount for a days supply of the drugs (other than 1 month) on this tier, using an out-of-network pharmacy (OONP) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a one month supply of a drug on this tier, when using an in-network preferred pharmacy (INPP; also known as a preferred pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 2 month supply of a drug on this tier, when using an in-network preferred pharmacy (INPP; also known as a preferred pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 3 month supply of a drug on this tier, when using an in-network preferred pharmacy (INPP; also known as a preferred pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a one month supply of a drug on this tier, when using mail order preferred pharmacy (MOPP) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 2 month supply of a drug on this tier, when using mail order preferred pharmacy (MOPP) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 3 month supply of a drug on this tier, when using mail order preferred pharmacy (MOPP) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a one month supply of a drug on this tier, when using mail order non-preferred pharmacy (MONPP; also known as a standard mail order pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 2 month supply of a drug on this tier, when using mail order non-preferred pharmacy (MONPP; also known as a standard mail order pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 3 month supply of a drug on this tier, when using mail order non-preferred pharmacy (MONPP; also known as a standard mail order pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a one month supply of a drug on this tier, when using an in-network non-preferred pharmacy (INNPP; also known as a standard retail pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 2 month supply of a drug on this tier, when using an in-network non-preferred pharmacy (INNPP; also known as a standard retail pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 3 month supply of a drug on this tier, when using an in-network non-preferred pharmacy (INNPP; also known as a standard retail pharmacy within a split network) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a one month supply of a drug on this tier, when using a standard mail order pharmacy during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 2 month supply of a drug on this tier, when using a standard mail order pharmacy during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 3 month supply of a drug on this tier, when using a standard mail order pharmacy during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a one month supply of a drug on this tier, when using an in-network pharmacy (INP; also known as a standard retail pharmacy) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 2 month supply of a drug on this tier, when using an in-network pharmacy (INP; also known as a standard retail pharmacy) during the coverage gap phase of the Part D benefit.
This variable identifies the number of days in a 3 month supply of a drug on this tier, when using an in-network pharmacy (INP; also known as a standard retail pharmacy) during the coverage gap phase of the Part D benefit.
Indicates whether the formulary tier has extra coverage in the during the coverage gap phase.
For Part D plans with some cost sharing in the gap (gap_tier = Yes), this variable indicates whether or not the the cost sharing applies to a partial list of drugs. If only a limited number of drugs on the tier are covered through the gap then the value will be 'Y'. If all drugs on the tier are covered through the gap then the value will be 'N'.
Most current gender in Medicare records (BENE_LCL_SEX_CD)
The sex of a beneficiary.
The sex of a beneficiary.
This field contains the total charge amount for gene therapy drugs.
This is the generic name of the dispensed PDE, according to the First DataBank (FDB) reference files. It is the drug ingredient name adopted by United States Adopted Names (USAN).
When this variable appears in the Formulary file, it is the FDB generic name for a drug product on the formulary.
The data in this column identifies the patient's ability for self care prior to the current illness, exacerbation or injury.
Indicates the resident's need for assistance with bathing dressing using the t
The data in this column indicates the patient's need for assistance with walking from room to room (with or without a device such as a cane or walker) prior to the current illness, exacerbation, or injury.
The data in this column identifies the patient's need for assistance in walking from room to room (with or without a device such as a cane, crutch or walker) prior to the current illness, exacerbation or injury.
Indicates the resident's need for assistance with walking from room to room (wit
The data in this column identifies the patient's need for assistance with internal or external stairs (with or without and a device such as cane, crutch or walker) prior to the current illness, exacerbation or injury.
Indicates the resident's need for assistance with internal or external stairs (w
Indicates the resident's need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury.
The data in this column identifies the patient's need for assistance with planning regular tasks such as shopping or remembering to take medication prior to the current illness,exacerbation or injury.
The data in this column indicates if the patient used a manual wheelchair prior to the current illness, exacerbation, or injury.
The data in this column identifies the patient's use of a manual wheelchair prior to the current illness, exacerbation or injury.
Indicates the resident's use of a manual wheelchair prior to the current illness, exacerbation, or injury.
The data in this column indicates if the patient used a motorized wheelchair and/or scooter prior to the current illness, exacerbation, or injury.
The data in this column identifies the patient's use of a motorized wheelchair and/or scooter prior to the current illness, exacerbation or injury.
Indicates the resident's use of a motorized wheelchair prior to the current illness, exacerbation, or injury.
The data in this column indicates if the patient used a mechanical lift prior to the current illness, exacerbation, or injury.
The data in this column identifies the patient's use of a Mechanical lift prior to the current illness, exacerbation or injury.
Indicates the resident's use of a mechanical lift prior to the current illness, exacerbation, or injury.
Indicates the resident's use of a mechanical lift prior to the current illness, exacerbation, or injury.