Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information

The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans). These non-identifiable files are available on a quarterly basis and are comprised of the following tables:

Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, and prior authorization.
Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators.
Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).
Partial Gap Coverage - Plan-RxCUI combinations that are on tiers that offer gap coverage for some drugs on the tier.
Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
Insulin Beneficiary Cost File - Plan level cost sharing details for insulin at preferred, non-preferred and mail order network pharmacies.

These are large files and can take time to download. 

Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.

The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information is also available to access for the monthly level information.

Please note:  The Part D benefit year information for plans become available in October of the year prior. For example, year 2024 data is available in the fourth quarter file of 2023. Year 2024 data continues to be available in the Q1-Q3 2024  files, then in the fourth quarter of 2024 year 2025 data becomes available. 

Estimated release dates for upcoming 2025 quarterly data (files reflect data for the quarter that ended the month before the file was released):

1/29/25
4/23/25
7/30/25

Files older than contract year 2019 can be purchased.

本季度处方药物计划药品目录、药店网络及定价信息文件收录了针对医疗保险处方药物计划和医疗保险优势计划（MA）处方药物计划的药品目录、药店网络及定价数据（雇主和全面护理老年人计划除外）。这些非可识别文件按季度提供，并包含以下表格内容：

- 计划信息：包括计划名称、合同ID、计划ID、服务区域和计划类型等信息。
- 地理定位：MA和处方药物计划的区域代码和县代码。
- 基础药物目录：包含每个计划的目录详情，包括国家药物代码（NDC）、成本分担层级以及阶梯治疗、数量限制和预先授权的指标。
- 排除药物目录：增强替代计划可自愿提供补充福利并覆盖排除药物。文件包含计划覆盖的排除药物目录详情（仅限增强替代计划）。
- 受益人成本：计划级别的优选、非优选和邮购网络药房的成本分担详情。
- 药店网络：包含每个网络药店的全国提供者识别号（NPI）以及优选、零售和邮购指标。
- 定价：计划级别的药品目录D部分平均月成本（请注意：此表格仅存在于季度文件中）。
- 部分差距覆盖：处于提供某些药物差距覆盖层级的计划-RxCUI组合。
- 基于指征的覆盖目录文件：包含基于每个计划的FDA批准指征覆盖的药物。
- 胰岛素受益人成本文件：计划级别的胰岛素成本分担详情，包括优选、非优选和邮购网络药房。

这些文件规模庞大，下载可能需要较长时间。

请参阅以下资源部分中的“使用协议”。该文件包含有关获取数据的时间框架、数据准确性和完整性的重要信息。

每月处方药物计划药品目录和药店网络信息也可用于访问月度层级信息。

请注意：计划的D部分福利年度信息在上一年的十月份提供。例如，2024年的数据可在2023年第四季度的文件中获取。2024年的数据将继续在2024年第一季度至第三季度的文件中提供，然后在2024年第四季度，2025年的数据将变得可用。

预计即将发布的2025年季度数据的发布日期（文件反映的是文件发布前一个月结束的季度数据）：

- 2025年1月29日
- 2025年4月23日
- 2025年7月30日

2019年之前的文件可以购买。