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This variable is contained in the following files: Plan Characteristics File
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%.

Comments

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)

CodeCode value
N
Not a specialty tier
Y
Specialty tier