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SAS Name
GAP_TIER_DRUG_TYPE
This variable identifies what types of drugs, if any, are covered on each formulary tier during the coverage gap phase. A tier may include multiple drug types.
Binary character string where each digit is a 1 or 0 to accommodate a variety of types of
drugs. For example, if the value = 110000 (1s in the 1st and 2nd digits), then generic and
non-preferred brand drugs are covered on this tier during the coverage gap phase.
drugs. For example, if the value = 110000 (1s in the 1st and 2nd digits), then generic and
non-preferred brand drugs are covered on this tier during the coverage gap phase.
| Code | Code value |
|---|---|
| 1 in 1st digit | Non-Preferred Brand |
| 1 in 2nd digit | Generic |
| 1 in 3rd digit | Preferred Generic |
| 1 in 4th digit | Non-Preferred Generic |
| 1 in 5th digit | Brand |
| 1 in 6th digit | Preferred Brand |
This field is only populated if the plan has an enhanced benefit design with extra coverage in the gap. There is variation in the number of formulary tiers over time. 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)