The Medicare Part D Formulary file is a suite of five sub-files: Formulary, Excluded Drug, Over-the-Counter Drug, Indication-based Formulary, and Part D Senior Savings (PDSS) Model that contain information on how the plan covers the prescription drugs filled (as described in the Part D Drug Event (PDE) file.
What does this file include? (variable highlights)
- CCW Formulary Drug Identifier
- Tier ID
- Step Therapy Indicator
- Quantity Limit
- Prior authorization
- Linking variables to the PDE file record:
- Formulary Identification Number (in each sub-file)
Why do researchers request this file?
- To examine differences in utilization based on formulary inclusion or restrictions
- To examine plan differences in formularies
Special considerations
- Linking variables provide information for each Part D Drug Event (PDE) record.
- The Tier ID available in this file may be linked to the Plan Characteristics File.
