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This variable is contained in the following files: Plan Characteristics File
SAS Name
PRE_ICL_APPLY

This variable indicates how the Part D plan charges cost-sharing before the Initial Coverage Limit (ICL) is reached.

Comments

The Initial Coverage Limit (ICL) phase of the Part D benefit is also referred to as the coverage gap.

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
Medicare-Defined Part D Coinsurance Amount
2
Cost Share Tiers
3
No Cost Sharing