Updated research request forms and data security approval requirement effective 4/24/23
This variable indicates whether the Part D plans that offer some cost sharing in the gap (i.e., those where the GAP_TIER value for this tier = "Y" [yes]), this variable indicates whether or not the cost sharing applies to a partial list of drugs. If only a limited number of drugs on the tier are covered during the gap then this value will be 'Y'. If all drugs on the tier are covered through the gap then this value will be 'N'. Applies only to enhanced plans with gap coverage.
| Code | Code value |
|---|---|
| Y | Yes |
| N | No |
| 9 | Not Applicable |
| X | Unknown |
This variable was new in 2008. There are different variables to describe all possible tiers in the coverage gap benefit phase. See also GAP_PARTIAL_TIER_01 - GAP_PARTIAL_TIER_07. For 2011 and later, there were only six tiers (i.e., variable called GAP_PARTIAL_TIER_07 was not applicable after 2010). 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 Part D plan sponsors to CMS’s Health Plan Management System (HPMS).