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

Description

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 2024 quarterly data (files reflect data for the quarter that ended the month before the file was released): 7/18/24 Files older than contract year 2019 can be purchased.

Resources

Name Format Description Link
57 SPUF_2023_20221202.zip https://data.cms.gov/sites/default/files/2023-11/3d945d0b-d8c3-4d13-b22f-175409cb5637/SPUF_2023_20221202.zip
57 SPUF_2021_20201204.zip https://data.cms.gov/sites/default/files/2023-11/b0a1128b-d032-4b79-8714-9126390b23b9/SPUF_2021_20201204.zip
57 SPUF_2022_20220311.zip https://data.cms.gov/sites/default/files/2023-11/f0c81466-a928-4618-904e-9828e843f970/SPUF_2022_20220311.zip
57 SPUF_2020_20200228.zip https://data.cms.gov/sites/default/files/2023-11/918dad58-7e10-4472-8c5c-cecf4c2bd8bb/SPUF_2020_20200228.zip
57 SPUF_2022_20211203.zip https://data.cms.gov/sites/default/files/2023-11/299daa79-cf13-49f5-95d0-5b653531620e/SPUF_2022_20211203.zip
57 SPUF_2021_20210604.zip https://data.cms.gov/sites/default/files/2023-11/699bf435-1dee-4c00-b5a6-61b5fd63d773/SPUF_2021_20210604.zip
57 SPUF_2020_20200911.zip https://data.cms.gov/sites/default/files/2023-11/1f9bd73c-58af-492b-b10b-ec6c272adc7c/SPUF_2020_20200911.zip
57 SPUF_2019_20190828.zip https://data.cms.gov/sites/default/files/2023-11/24297f86-31e1-4235-b1ac-2ecbc974ff7c/SPUF_2019_20190828.zip
57 SPUF_2024_20240411.zip https://data.cms.gov/sites/default/files/2024-04/329795bb-f6f3-40f5-8cf8-d185cf3c6074/SPUF_2024_20240411.zip
57 SPUF_2020_20200605.zip https://data.cms.gov/sites/default/files/2023-11/a726d34f-e277-41a3-9f0f-c2b3f58f60fc/SPUF_2020_20200605.zip
57 SPUF_2024_20240111.zip https://data.cms.gov/sites/default/files/2024-01/596629a6-d6e1-406d-a589-93baa2f0fff4/SPUF_2024_20240111.zip
57 SPUF_2023_20230310.zip https://data.cms.gov/sites/default/files/2023-11/d83b7a01-221a-436a-bf0f-233f1fe59a76/SPUF_2023_20230310.zip
57 SPUF_2022_20220909.zip https://data.cms.gov/sites/default/files/2023-11/ff4b27e3-e375-4853-b926-20e3519f2d02/SPUF_2022_20220909.zip
57 SPUF_2023_20230908.zip https://data.cms.gov/sites/default/files/2023-10/d4409666-b539-45f9-80e4-7dbfbbdd8647/SPUF_2023_20230908.zip
57 SPUF_2023_20230602.zip https://data.cms.gov/sites/default/files/2023-11/04be6f2c-0db3-462e-8406-7d4285f81c78/SPUF_2023_20230602.zip
57 SPUF_2022_20220603.zip https://data.cms.gov/sites/default/files/2023-11/288ea007-4e9f-4cd3-a138-1591b9540f52/SPUF_2022_20220603.zip
57 SPUF_2020_20191206.zip https://data.cms.gov/sites/default/files/2023-11/9a86dccd-f839-48d3-85fc-cbcda6be97f3/SPUF_2020_20191206.zip
57 SPUF_2019_20190605.zip https://data.cms.gov/sites/default/files/2023-11/a1286701-8c9b-408d-91b5-140b9aceb666/SPUF_2019_20190605.zip
57 SPUF_2019_20190227.zip https://data.cms.gov/sites/default/files/2023-11/ee424519-cbdf-4c50-b180-0b9497a50641/SPUF_2019_20190227.zip
57 SPUF_2021_20210226.zip https://data.cms.gov/sites/default/files/2023-11/2b74bb8d-73f3-464d-80ee-22d10c10a4ad/SPUF_2021_20210226.zip
57 SPUF_2021_20210910.zip https://data.cms.gov/sites/default/files/2023-11/10ee59e8-8b96-4607-96fe-c65c943c685a/SPUF_2021_20210910.zip

Tags

  • drugs
  • medicare-prescription-drug
  • medicare
  • all-other-provider-care-types
  • health-care-use-payments

Topics

Categories