Updated research request forms and data security approval requirement effective 4/24/23
SAS Name
POST_OOPT_COSTSHARE_TYPE
This variable identifies the type of cost sharing that drugs on the tier are subject to for each formulary tier during the post-out-of-pocket threshold phase (also known as the catastrophic coverage phase). Cost-sharing may include copayment, co- insurance, or the greater/lesser of the two.
| Code | Code value |
|---|---|
| 1 | Coinsurance |
| 2 | Copayment |
| 3 | Greater of Coinsurance and Copayment |
This variable was new in 2007. This field is only populated if the Medicare-defined Post Threshold Cost Shares do not apply. The catastrophic coverage phase is also referred to as the post-out-of-pocket threshold phase 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). 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)