Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for Download

ATTENTION: Beginning in January 2021, these files are available as free downloads. Please note that these are large files and can take time to download. The last two years of files (contract years 2019 and 2020) are also available to download for free.
 
The full schedule for contract year (CY) 2024 data files is posted below.

Files older than contract year 2019 can be purchased at https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/NonIdentifiableDataFiles/PrescriptionDrugPlanFormularyPharmacyNetworkandPricingInformationFiles. 

Overview of Files: The Part D 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.
• 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.

Data dictionaries for each table and information on how to link across the tables is available in the record layout file. The record layout and data dictionary for the formulary file are subject to change.

Please read the “Agreement for Use” provided with the files. 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.

Please note: The new Part D benefit year information for plans are available in the October, November and December monthly files, and 4^th quarterly file. (i.e., year 2024 data is available in the October 2023 monthly file and the 4^th quarter 2023 file). Part D benefits and formulary are included in monthly and quarterly files; estimated drug pricing data is only available in quarterly files. 

Free Monthly and Quarterly Downloads: Click on the file to download in the tables below.  These are large files and can take time to download.

• Data Format: CSV text file
• Approximate Size: 2.5 GB
• 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:  See record layouts below; they are also included in the downloadable files.