This variable identifies the average expected cost-sharing amount in dollars for beneficiary co-insurance for a 1 month supply of the drugs on this tier, using an innetwork non-preferred preferred pharmacy (INNPP; also known as a standard retail pharmacy within a split network) during the pre-initial coverage limit (ICL) phase of the Part D benefit.
CMS instructed plans to calculate this amount by including the average expected cost-sharing amount in dollars that a beneficiary would be expected to pay at a network retail pharmacy for a one month supply of drugs. This estimate should be based on available plan data (such as the most current 6 months of PDE data) for retail pharmacies only. Neither retail extended day supply nor mail order location data should be included in the estimate. Plans that use a co-payment amount rather than a coinsurance percentage will not have a value in this field.
Starting in 2016, CMS changed how they describe pharmacy networks. The INNPP are currently referred to as standard retail pharmacies within split networks. There is no change in the meaning of the variable, and the data values are the same over time.
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)