Pre-ICL Out-of-Network Pharmacy Coinsurance for 1 month Supply
SAS Name
PRE_ICL_OONP_COINS_1M
This variable identifies the beneficiary co-insurance percentage for a 1 month supply of the drugs on this tier, using an out-of-network pharmacy (OONP) 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_OONP_COPAY_1M).
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.
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_OONP_COPAY_1M).
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)