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The Medicare Part D Formulary file is a suite of three sub-files: formulary, excluded drug and Over the Counter Drug that contain information on how the plan covers the prescription drugs filled (as described in the Part D Drug Event (PDE) file.

What does this file include? (variable highlights)

  • CCW Formulary Drug Identifier
  • Tier ID
  • Step Therapy Indicator
  • Quantity Limit
  • Prior authorization
  • Linking variables to the PDE file record:
    • Formulary Identification Number (in each sub-file)

Why do researchers request this file?

  • To examine differences in utilization based on formulary inclusion or restrictions
  • To examine plan differences in formularies

Special considerations

  • Linking variables provide information for each Part D Drug Event (PDE) record.
  • The Tier ID available in this file may be linked to the Plan Characteristics File.
Program
Medicare
Category
Privacy Level
Research Identifiable Files