Part D Formulary Information in the CMS Data Files

Purpose

Detailed information about Medicare Part D drug plan formularies is available in two CMS data files. Important differences in the files are outlined below, including whether or not the files can be linked to other data sources.

Current Version Date:

07/16/2018

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Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information

The Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information File is a non-identifiable file is a non-identifiable file available from the Centers for Medicare and Medicaid Services (CMS) website.

The information in this file, including the plan identity, is not encrypted. This means that the file contains the actual identity of a Part D plan. These may be linkable to the Research Identifiable (RIF) Part D event (PDE) data and Master Beneficiary Summary File (A/B/C/D) if the identifiers in the RIF data are unencrypted. If the data that you received contain encrypted identifiers, you will not be able to link to this file.

Part D Formulary File

A Part D Formulary file is a Research identifiable file available from CMS beginning in 2010. This Part D Formulary file is linkable to the formulary identifier on the RIF Part D event data (PDE) even if the identifiers are encrypted. The release of this formulary file will coincide with the release of the RIF PDE data, so data availability will typically lag about two years (i.e. 2015 data became available in 2017).
Note: The formulary ID was always encrypted prior to the 2013 data release.

Summary

If your Part D data contain encrypted identifiers, you will only be able to use the Part D formulary file to obtain formulary information. If your data have unencrypted identifies, you may link to either the Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information File (non-identifiable file) or the Part D Formulary File (research identifiable file). The Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information File contains information beginning in 2005; the Part D Formulary File begins in calendar year (CY) 2010.

The Part D user guide from the Chronic Conditions Warehouse contains helpful information about these and other Part D files.

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Article Information

Author:

Stephanie Jarosek, PhD, BSN

Level:

Introduction

Topic:

Data Files or Variables

Program:

Medicare

Category:

Part D, Plan and Provider

Disclaimer:

The process and materials mentioned as part of this KnowledgeBase article are current, as of the publication date on the article, to the best of our knowledge. The examples provided are correct in the aggregate but may not apply to every subgroup or circumstance that a researcher may wish to study. It is up to the researcher to conduct analysis and confirm that the patterns described in this KnowledgeBase article apply to his/her particular study. If your research findings appear to contradict the advice provided, please contact ResDAC at resdac@umn.edu.