Updated research request forms and data security approval requirement effective 4/24/23
SAS Name
PRE_ICL_TIER_DRUG_TYPE
This variable identifies what types of drugs, if any, are covered on each formulary tier during the pre-initial coverage limit (ICL) phase. A tier may include multiple drug types.
Binary character string where each digit is a 1 or 0 to accommodate a variety of types of
drugs. For example, if the value = 110000 (1s in the 1st and 2nd digits), then generic and
non-preferred brand drugs are covered on this tier during the pre-ICL phase.
drugs. For example, if the value = 110000 (1s in the 1st and 2nd digits), then generic and
non-preferred brand drugs are covered on this tier during the pre-ICL phase.
| Code | Code value |
|---|---|
| 1 in 1st digit | Non-Preferred Brand |
| 1 in 2nd digit | Generic |
| 1 in 3rd digit | Preferred Generic |
| 1 in 4th digit | Non-Preferred Generic |
| 1 in 5th digit | Brand |
| 1 in 6th digit | Preferred Brand |
| All 9's | Not Applicable |
There are a different number of records for each year to describe tiers, due to variation in the number of formulary tiers 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)