Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files
These public use files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug Plans (with the exception of employer and PACE plans). The Formulary and Pharmacy Network File will be updated monthly with updates being available at the end of the first complete week of each month. Additionally, a file containing formulary, pharmacy network, and pricing data will be available on a quarterly basis.
These public use files are comprised of the following files:
- Geographic Locator File - Includes the MA and PDP Region codes and county codes
- Plan Information File - Includes information for each plan (name, contract ID, plan ID, service area, plan type, etc.)
- Formulary File - Formulary details for each plan including NDCs, Tier Level, and indicators for Step Therapy, Quantity Limits, and Prior Authorization.
- Beneficiary Cost File - Plan level cost sharing details for preferred, non-preferred and mail order network pharmacies.
- Pharmacy Network File - NPI numbers for each network pharmacy including preferred, retail, and mail order indicators.
- Pricing File - Included in the quarterly file, plan level average monthly costs for formulary Part D drugs.
- Record Layout - This file includes a diagram of file linkages, plus separate data dictionaries for each of the files listed above. The record layout and data dictionary for the Formulary file are subject to change. Please check the data dictionary shipped with your order. For viewing the data dictionaries on-line, please see the Record Layout files in Downloads below.
Common data elements in each file include Contract ID, Plan ID, and Segment ID (if applicable).
Use of these files will require access to the following data sources:
- National Council for Prescription Drug Programs, Inc (NCPDP) data access to crosswalk the NPI unique pharmacy numbers to pharmacy names and addresses in the Pharmacy Network File.
- Drug databases such as MediSpan or First DataBank to crosswalk NDCs to drug names in the Formulary File.
TERMS AND CONDITIONS FOR USE OF PART D FORMULARY, PHARMACY NETWORK, AND PRICING INFORMATION
The Part D Formulary, Pharmacy Network, and Pricing Information are public use files being provided by the Centers for Medicare & Medicaid Services (CMS), and any use of such information by Requesting Party must be in a manner consistent with these Terms and Conditions. By requesting and using the Formulary, Pharmacy Network, and Pricing Information, requesting party agrees that it will comply with these Terms and Conditions. See full Terms and Conditions in the Downloads area below.
Data Format: CSV text file
Approximate Size: 10 MB
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)
Monthly - Prescription Drug Plan Formulary and Pharmacy Network Files:
Media: CD ROM
File Cost: $250.00 per month
Available: Monthly updates starting December 2005
The release dates for 2016 data are:
10/03/15, 11/12/15, 12/10/15, 01/07/16, 02/04/16, 03/17/16, 04/14/16, 05/12/16, 06/09/16, 07/07/16, 08/04/16
Quarterly - Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information:
Media: CD ROM
File Cost: $750.00 per quarter
Available: Quarterly updates starting May 2009
The release dates for CY 2016 data are:
01/07/16, 04/18/16, 06/30/16, 09/2016
The new year of Part D Plan pricing data will first appear in the October file (i.e., year 2016 pricing data available in the October 2015 file).
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.
- Terms and Conditions for Use of Part D Formulary, Pharmacy Network, and Pricing Information [PDF, 19KB]
- Record Layout for 2016 Monthly File Update [PDF, 59KB]
- Record Layout for 2016 Monthly File [PDF, 173KB]
- Record Layout for 2015 Monthly File [PDF, 205KB]
- Record Layout for 2016 Quarterly File Update [PDF, 58KB]
- Record Layout for 2016 Quarterly File [PDF, 177KB]
- Record Layout for 2015 Quarterly File [PDF, 206KB]
- Order form and general ordering instructions [ZIP, 56KB]
- Page last Modified: 11/10/2015 9:06 AM
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