Pre-ICL Coinsurance Split Network Standard Mail Order - 1 month supply

SAS Name
PRE_ICL_MONPP_COINS_1M

This variable identifies the beneficiary co-insurance percentage for a 1 month supply of the drugs on this tier, using mail order non-preferred pharmacy (MONPP; also known as a standard mail order pharmacy within a split network) during the pre-initial coverage limit (ICL) phase of the Part D benefit.

Comments

Plans that use a co-payment amount rather than a coinsurance percentage will not have a value in this field; see instead the corresponding co-payment variable called (PRE_ICL_MONPP_COPAY_1M).

Starting in 2016, CMS changed how they describe pharmacy networks. The MOPP are currently referred to as standard mail order 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)