Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files
Overview of File: The 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 monthly and 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
- 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
- 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
- Drug pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files) *As of the 4th quarter 2019 quarterly file, Plan level average monthly costs for formulary Part D drugs will be aggregated to the average unit cost for all retail pharmacies per plan.
Data dictionaries for each table and information on how to link across the tables is available in the record layout in the Downloads section below. The record layout and data dictionary for the formulary file are subject to change.
Before beginning the process to request these files, please read the “Terms and Conditions for Use of Part D Formulary, Pharmacy Network, and Pricing Information” in the Downloads section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.
Data Availability: These data are available in monthly or quarterly files. The first monthly data available is December 2005. The first quarterly data available is quarter 1 (January – March) of 2009.
Please note: The new year of Prescription Drug Plan data becomes available in October. The new year of data will begin to be reported in the October monthly file and in the January quarterly file (i.e., year 2018 data is available in the October 2017 monthly file and the January 2018 quarterly file). Drug pricing data is only available in quarterly files.
- Monthly release dates for 2020 data (all dates are estimates): 10/06/19, 11/15/19, 12/13/19, 01/10/20, 02/07/20, 03/06/20, 04/17/20, 05/15/20, 06/12/20, 07/10/20, 08/07/20, 9/15/20
- Quarterly release dates for 2020 data (all dates are estimates): 01/13/20, 03/30/20, 07/06/20 (note: these files reflect data for the previous quarter)
Cost: File cost differs between the monthly files and the quarterly files.
- Monthly: $250.00 per month
- Quarterly: $750.00 per quarter
Data Format: CSV text file
Approximate Size: 10 MB
Media: CD-ROM or DVD
Compatible Software Programs: Microsoft SQL/DB2/Oracle, SAS or other statistical software. (Note: Microsoft Excel, Microsoft Access, or TextPad cannot be used to analyze the formulary files.)
Notes or Special Instructions: As of the CY 2016 November (2015) Monthly File, both the monthly and quarterly files will have updated record layouts. These record layout files can be downloaded from the files below.