Updated research request forms and data security approval requirement effective 4/24/23
SAS Name
SPECIALTY_TIER
This variable indicates whether the formulary tier is designated as a specialty tier. The specialty tier contains high cost products which must meet a certain monthly dollar threshold as set by CMS, and products on this tier are typically limited to a percentage coinsurance of 25%, and cannot exceed 33%.
| Code | Code value |
|---|---|
| N | Not a specialty tier |
| Y | Specialty tier |
The CCW constructs the Plan Characteristics File from information submitted by plan sponsors to CMS’s Health Plan Management System (HPMS).
Source: CMS (HPMS Files)