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, prior authorization, and a newly added Selected Drug flag.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, and brand, generic, and selected drug dispensing fees for 30/60/90 days supply, respectively.Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.Insulin Beneficiary Cost File - Plan level copay and coinsurance amounts for insulin at preferred, non-preferred and mail order network pharmacies.