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.

季度处方药计划处方集、药房网络与定价信息文件，包含联邦医疗保险（Medicare）处方药计划及联邦医疗保险优势（Medicare Advantage, MA）处方药计划（雇主赞助计划及全关怀老年护理计划除外）的处方集、药房网络与定价数据。此类非识别性文件按季度发布，包含以下数据表：1. 计划信息表：涵盖计划名称、合同编号、计划编号、服务区域及计划类型等信息。2. 地理定位表：包含MA及处方药计划的区域代码与县代码。3. 基础药品处方集表：包含各计划的处方集详情，包括国家药品代码（National Drug Codes, NDCs）、费用分担层级，以及阶梯治疗、用量限制、事前审批的标识项，还有新增的选定药品标识（Selected Drug flag）。4. 除外药品处方集表：升级替代计划可选择提供补充福利并覆盖除外药品，本文件仅包含该类计划所覆盖的除外药品的处方集详情。5. 参保者费用表：包含优选药房、非优选药房及邮购药房的计划层级费用分担详情。6. 药房网络表：包含各网络药房的国家提供者标识符（National Provider Identifier, NPI）编号，涵盖优选、零售及邮购标识项，以及30/60/90天取药量对应的品牌药、仿制药与选定药品的配药费用。7. 定价表：包含计划层级的D部分处方药的月度平均成本（注：该数据表仅在季度文件中提供）。8. 基于适应症的覆盖范围处方集表：包含各计划根据美国食品药品监督管理局（Food and Drug Administration, FDA）批准的适应症所覆盖的药品。9. 胰岛素参保者费用表：包含计划层级下优选、非优选及邮购药房的胰岛素共付额与比例共付金额。