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This variable is contained in the following files: Part D Drug Event File
Short SAS Name
BNFTPHAS
SAS Name
BENEFIT_PHASE

This is a CCW-derived field that indicates the benefit phase in which the prescription likely occurred. This is done by ordering the beneficiary's claims by their dates of service and then comparing the cost of those PDEs to the benefit structure for the beneficiary’s plan.  

The benefit phase is described using a two-digit code. The first digit indicates the benefit phase immediately before the prescription was filled, and the second digit indicates the benefit phase immediately after the prescription was filled.  The two digits are necessary because the benefit phases depend on specific dollar amounts and often do not split exactly between prescription fills; that is, a particular PDE may “straddle” more than one benefit phase.  For example, “DD” indicates that the beneficiary was in the deductible phase of the benefit both before and after filling the prescription, but “PI” indicates that this PDE occurred partly in the pre-ICL phase and partly in the coverage gap.

Comments

Some non-standard combinations of benefit phases might appear, particularly if a beneficiary changed plans during the year.   

The CCW creates this variable based on the beneficiary’s plan benefit package at the time of the prescription was filled (using the Part D contract and plan of record which appear in the CCW Master Beneficiary Summary A/B/D file).  For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be accurate. 

Source: PDE (derived)

CodeCode value
Null/blank
Not a covered drug
CC
PDE occurred in catastrophic phase
DC
PDE straddled deductible and catastrophic phases
DD
PDE occurred in deductible phase
DI
PDE straddled deductible and ICL (coverage gap) phases
DP
PDE straddled deductible and pre-ICL phases
IC
PDE straddled ICL (coverage gap) and catastrophic phases
II
PDE occurred in ICL (coverage gap) phase
NA
Beneficiary enrolled in PACE or employer-sponsored plan
PC
PDE straddled pre-ICL and catastrophic straddle phases
PI
PDE straddled pre-ICL and ICL (coverage gap) phases
PP
PDE occurred in pre-ICL phase
XX
PDE plan identifiers do not link to the plan benefit file