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SAS Name
GAP_MONPP_COPAY_2M
This variable identifies the beneficiary co-payment amount for a 2 month supply of the drugs on this tier, using a 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 will only be populated if the plan has an enhanced benefit design with extra coverage in the gap. The coverage gap is technically referred to as the initial coverage limit (ICL) for the Part D benefit. Plans that use a coinsurance percentage rather than a co-payment amount will not have a value in this field; see instead the corresponding co-payment variable called (GAP_MONPP_COINS_2M).
Starting in 2016, CMS changed how they describe pharmacy networks. The MOPP are currently referred to as standard mail order pharmacies within split networks. There is no change in the meaning of the variable, and the data values are the same over time.
The CCW constructs the Plan Characteristics File from information submitted by plan sponsors to CMS’s Health Plan Management System (HPMS). Employer and National Program of All-inclusive Care for the Elderly (PACE) plans are waived from reporting Plan Benefit Package information.
For those plans that did not report, the value of this variable will be blank.
Source: CMS (HPMS Files)