Pre-ICL In-Network Pharmacy Coinsurance for 1 month Supply on Tier 8
SAS Name
PRE_ICL_INNPP_COPAY_1M
This variable identifies the beneficiary co-insurance percentage for a 1 month supply of the drugs on this tier, using an in-network pharmacy during the pre-initial coverage limit (ICL) phase of the Part D benefit.
Comments
This variable was new in 2007. It changed from 12 digits to 8 in 2009.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_INP_1M_COPAY_TIER_01).There are a different number of the variables each year to describe tiers, due to variation in the formulary tiers over time. There are different variables to describe all possible tiers in the pre-ICL benefit phase. See also PRE_ICL_INP_1M_COINS_TIER_01 - PRE_ICL_INP_1M_COINS_TIER_09.During 2008- 2010 there were only seven tiers (i.e., variables PRE_ICL_INP_1M_COINS_TIER_08 and PRE_ICL_INP_1M_COINS_TIER_09 were not applicable). For 2011 and later, there were only six tiers (i.e., variable called PRE_ICL_INP_1M_COINS_TIER_07 was not applicable after 2010).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.^ Back to TOC
This variable was new in 2007. It changed from 12 digits to 8 in 2009.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_INP_1M_COPAY_TIER_01).There are a different number of the variables each year to describe tiers, due to variation in the formulary tiers over time. There are different variables to describe all possible tiers in the pre-ICL benefit phase. See also PRE_ICL_INP_1M_COINS_TIER_01 - PRE_ICL_INP_1M_COINS_TIER_09.During 2008- 2010 there were only seven tiers (i.e., variables PRE_ICL_INP_1M_COINS_TIER_08 and PRE_ICL_INP_1M_COINS_TIER_09 were not applicable). For 2011 and later, there were only six tiers (i.e., variable called PRE_ICL_INP_1M_COINS_TIER_07 was not applicable after 2010).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.^ Back to TOC