This is a CCW-derived field that indicates whether the prescription was subject to a step therapy protocol, according to the benefit structure and formulary for the beneficiary’s plan. If a product is part of two different step therapy protocols, this field is populated with the maximum step value for the product.
If the value is greater than 1, then the beneficiary’s plan imposed some type of step therapy requirement, and the value indicates the number of steps or therapy trials needed before becoming eligible for the current drug.
Part D plan sponsors submit the pricing, tiers, and formularies for their plan benefit
packages to CMS via the Health Plan Management System (HPMS). This includes
information on which drugs are subject to step therapy, which requires a beneficiary to
first try one or more other medications in the same therapeutic class.
The value of this field may not exactly represent the beneficiary experience at the time
of the prescription fill (e.g., no data are collected at the time of the transaction to
indicate the actual beneficiary experience).
For 2006-2009 this variable was found in the Part D Event Characteristics Files. This
variable is first available in the Formulary File in 2010. It is also present in the Excluded
Drug File, starting with 2012 data.
Source: CMS (HPMS Files)