Back to top
This variable is contained in the following files: Plan Characteristics File
SAS Name
GAP_COSTSHARE_TYPE

This variable indicates the type of cost sharing drugs on the tier are subject to in the coverage gap phase, which may include copayment, co-insurance, or the greater/lesser of the two.

Comments

This variable applies only to enhanced plans with gap coverage. The coverage gap is technically referred to as the initial coverage limit (ICL) for the Part D benefit.

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)

CodeCode value
1
Coinsurance
2
Copayment