codebook-pde.xml

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<codebook name="Medicare Part D Event (PDE) / Drug Characteristics" version="May 2017, Version 1.0">
    <variable id="ADJSTMT_DLTN_CD" label="Adjustment Deletion Code" length="1" longName="ADJSTMT_DLTN_CD" shortName="ADJDELCD" source="PDE" type="CHAR">
        <comment>
            <p>Only the final version of the PDE at the time of payment reconciliation is included in the Part D standard analytic file (SAF).</p>
        </comment>
        <description>
            <p>This field distinguishes original from adjusted or deleted PDE records so CMS can adjust claims and make accurate payment for revised PDE records.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="Blank">Original PDE</value>
                <value code="A">Adjustment</value>
                <value code="D">Deletion</value>
                <value code="R">Resubmitted</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="BENE_ID" label="CCW Encrypted Beneficiary ID Number" length="15" longName="BENE_ID" shortName="BENE_ID" source="CCW" type="CHAR">
        <description>
            <p>The unique CCW identifier for a beneficiary.</p>
            <p>The CCW assigns a unique beneficiary identification number to each individual who receives Medicare and/or Medicaid, and uses that number to identify an individual’s records in all CCW data files (e.g., Medicare claims, MAX claims, MDS assessment data).</p>
            <p>This number does not change during a beneficiary’s lifetime and each number is used only once.</p>
            <p>The BENE_ID is specific to the CCW and is not applicable to any other identification system or data source.</p>
        </description>
    </variable>
    <variable id="BENEFIT_PHASE" label="Benefit Phase of Part D Event" length="2" longName="BENEFIT_PHASE" shortName="BNFTPHAS" source="PDE (derived)" type="CHAR">
        <comment>
            <p>Some non-standard combinations of benefit phases might appear, particularly if a beneficiary changed plans during the year.</p>
            <p>The CCW creates this variable based on the beneficiary’s plan benefit package at the time of the prescription was filled (using the Part D contract and plan of record which appear in the CCW Master Beneficiary Summary A/B/D file). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be accurate.</p>
        </comment>
        <description>
            <p>This is a CCW-derived field that indicates the benefit phase in which the prescription likely occurred. This is done by ordering the beneficiary's claims by their dates of service and then comparing the cost of those PDEs to the benefit structure for the beneficiary’s plan.</p>
            <p>The benefit phase is described using a two-digit code. The first digit indicates the benefit phase immediately before the prescription was filled, and the second digit indicates the benefit phase immediately after the prescription was filled. The two digits are necessary because the benefit phases depend on specific dollar amounts and often do not split exactly between prescription fills; that is, a particular PDE may “straddle” more than one benefit phase. For example, “DD” indicates that the beneficiary was in the deductible phase of the benefit both before and after filling the prescription, but “PI” indicates that this PDE occurred partly in the pre-ICL phase and partly in the coverage gap.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="Null/blank">Not a covered drug</value>
                <value code="CC">PDE occurred in catastrophic phase</value>
                <value code="DC">PDE straddled deductible and catastrophic phases</value>
                <value code="DD">PDE occurred in deductible phase</value>
                <value code="DI">PDE straddled deductible and ICL (coverage gap) phases</value>
                <value code="DP">PDE straddled deductible and pre-ICL phases</value>
                <value code="IC">PDE straddled ICL (coverage gap) and catastrophic phases</value>
                <value code="II">PDE occurred in ICL (coverage gap) phase</value>
                <value code="NA">Beneficiary enrolled in PACE or employer-sponsored plan</value>
                <value code="PC">PDE straddled pre-ICL and catastrophic straddle phases</value>
                <value code="PI">PDE straddled pre-ICL and ICL (coverage gap) phases</value>
                <value code="PP">PDE occurred in pre-ICL phase</value>
                <value code="XX">PDE plan identifiers do not link to the plan benefit file</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="BN" label="Brand Name" length="30" longName="BN" shortName="BN" source="First DataBank" type="CHAR" valueFormat="text description; DIABETIC SUPPLY for all diabetic supplies">
        <comment>
            <p>In the PDE file, this variable is populated by linking to the proprietary First DataBank MedKnowledge database by matching on the National Drug Code (NDC; variable in the PDE files called the product service identifier PROD_SRVC_ID).</p>
            <p>In the Formulary file, this variable is populated by matching the drug products on the Part D Plan submitted formulary to FDB. Part D plan sponsors submit the formulary to the CMS Health Plan Management System (HPMS). Plans identify the drug products on their formularies using the National Library of Medicine RxNorm Concept Unique Identifiers (RXCUIs). Each RXCUI corresponds to a unique brand name and clinical formulation (same ingredients, strength, and dosage form).</p>
            <p>Additional details regarding the FDB source data are available at: http://www.fdbhealth.com/fdb-medknowledge/</p>
        </comment>
        <description>
            <p>This is the brand name of the dispensed PDE, according to the First DataBank (FDB) reference files.</p>
            <p>The name that appears on the package label provided by the manufacturer.</p>
            <p>When this variable appears in the Formulary file, it is the FDB brand name for a drug product on the formulary.</p>
        </description>
    </variable>
    <variable id="BRND_GNRC_CD" label="Brand-Generic Code Reported by Submitting Plan" length="1" longName="BRND_GNRC_CD" shortName="BRNDGNCD" source="PDE" type="CHAR">
        <comment>
            <p>This variable was new in 2012.</p>
        </comment>
        <description>
            <p>Plan reported value indicating whether the plan adjudicated the claim as a brand or generic drug.</p>
            <p>Applies to covered drugs only.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="B">Brand</value>
                <value code="G">Generic Null/missing</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="CCW_PHARM_ID" label="CCW Pharmacy Identifier" length="12" longName="CCW_PHARM_ID" shortName="CCW_PHARM_ID" source="PDE and NCDPD dataQ™ (derived)" type="NUM" valueFormat="Null, or a 5-digit numeric value">
        <comment>
            <p>Investigators who wish to obtain Pharmacy Characteristics files must choose between the pharmacy IDs on the PDE (variable called the service provider ID [SRVC_PRVDR_ID]), or the CCW_PHARM_ID (or, starting in 2014, the proprietary NCPDP_ID) that will allow linkage between the PDE and Pharmacy Characteristics Files.</p>
            <p>Beginning with 2014 data, the NCPDP_ID is used in place of the CCW_PHARM_ID.</p>
            <p>Researchers who received CCW data from 2006-2013 and wish to identify the NCPDP_ID associated with the CCW_PHARM_ID may request the "Pharmacy Bridge File", which is designed for this purpose.</p>
            <p>This variable is populated by linking the service provider identification number (SRVC_PRVDR_ID) from the source PDE to the proprietary National Council for Prescription Drug Programs (NCPDP) dataQ™ Database. The variable is populated for every PDE that could be linked to the NCPDP pharmacy data for that year, and will occasionally be null if there was no conclusive link between the service provider identification number in the source PDE data and the provider identification numbers in the NCPDP pharmacy data.</p>
            <p>This variable usually represents a unique pharmacy entity, which historically was a retail store. However, as the pharmacy industry has evolved, some retail stores have added other lines of business, such as filling prescriptions for long-term care facilities. In these cases, the pharmacy can ask NCPDP to issue them more than one identification number to keep the billing separate for their multiple lines of business.</p>
            <p>Additional details regarding the NCPDP source data are available at: https://www.ncpdpdataq.org/dataQInfo/pages/dataQFiles.htm.</p>
        </comment>
        <description>
            <p>This is the CCW-assigned pharmacy identification number that is used to uniquely identify pharmacy entities. The ID is specific to the CCW and not applicable to any other identification system or data source.</p>
            <p>This field also enables linkage between pharmacies in the Part D Event File and the CCW Pharmacy Characteristics File (2006-2013; note that starting in 2014 the NCPDP_ID is used for linkage).</p>
            <p>This variable is only available 2006 - 2013.</p>
        </description>
    </variable>
    <variable id="CCW_PRSCRBR_ID" label="CCW Prescriber Identifier" length="12" longName="CCW_PRSCRBR_ID" shortName="CCW_PRSCRBR_ID" source="PDE and HCIdea™ Prescriber Database (derived)" type="NUM" valueFormat="Null, or any positive or negative number">
        <comment>
            <p>Beginning with 2014 data, this variable has been retired and researchers may obtain both the actual prescriber identifier (PRSCRBR_ID) and the CCW Prescriber Characteristics File. As of May 2013, the PRSCRBR_ID is always populated with the National Provider Identifier (NPI).</p>
            <p>Researchers who received CCW data from 2006-2013 and wish to identify the HCIdea-assigned provider ID (HCID) and/or NPI associated with the CCW_PRSCRBR_ID may request the "Prescriber Bridge File", which is designed for this purpose.</p>
            <p>For 2006-2013, this variable is the CCW-assigned prescriber identifier that is populated by linking the PRSCRBR_ID from the PDE to the proprietary HCIdea Prescriber Database.</p>
            <p>HCIdea has prescriber information from a variety of data sources, including the NPPES directory (the National Plan and Provider Enumeration System, which assigns a unique NPI to each provider), the Drug Enforcement Administration (through data files known as the Controlled Substances Act Registrants), and SureScripts (a nationwide e-prescribing network). Using these input files, it was generally possible for CCW to identify a unique provider using an NPI, DEA number, and/or UPIN number.</p>
            <p>This variable is populated for every PDE that could be linked to a provider in the HCIdea database for that year. CCW_PRSCRBR_ID has a negative value when a conclusive link could not be found between the prescriber identification number in the source PDE data and the HCIdea database.</p>
        </comment>
        <description>
            <p>This variable is the CCW-assigned number that is used to uniquely identify prescribers found in the Part D Event File. The ID is specific to the CCW and not applicable to any other identification system or data source.</p>
            <p>This field also enables linkage between the Part D Event File and the CCW Prescriber Characteristics File. This variable is only available 2006 - 2013.</p>
        </description>
    </variable>
    <variable id="CMPND_CD" label="Compound Code" length="2" longName="CMPND_CD" shortName="CMPND_CD" source="PDE" type="NUM">
        <description>
            <p>This field indicates whether or not the dispensed drug was compounded or mixed.</p>
            <p>Some prescribed drugs must be compounded to obtain the prescribed ingredients in the dosage and form that is necessary. When this occurs, the value of this variable should be 2.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="0">Not specified (missing values are also possible)</value>
                <value code="1">Not a compound</value>
                <value code="2">Compound</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="CTSTRPHC_CVRG_CD" label="Catastrophic Coverage Code" length="1" longName="CTSTRPHC_CVRG_CD" shortName="CATCOVCD" source="PDE" type="CHAR">
        <comment>
            <p>This variable was required for all PDEs through the end of 2010, and became optional starting in 2011.</p>
            <p>Note that the value may differ from the more detailed BENEFIT_PHASE variable, which is a CCW-derived field that is available for all years.</p>
        </comment>
        <description>
            <p>This variable indicates whether the PDE occurred within the catastrophic benefit phase of the Medicare Part D benefit, according to the source PDE.</p>
            <p>When the value equals C (above attachment point), then the PDE is in the catastrophic phase. When the value equals A (attachment point), the PDE has caused the beneficiary to move into the catastrophic phase (i.e., this is the “triggering” PDE).</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="A">Attachment point met on this event</value>
                <value code="C">Above attachment point</value>
                <value code="Blank">Attachment point not met</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="CVRD_D_PLAN_PD_AMT" label="Amount paid by Part D plan for the PDE (drug is covered by Part D)" length="10" longName="CVRD_D_PLAN_PD_AMT" shortName="CPP_AMT" source="PDE" type="NUM">
        <comment>
            <p>This variable comes directly from the original PDE.</p>
        </comment>
        <description>
            <p>This is the net amount that the Part D plan paid for a PDE that was covered by the Medicare Part D benefit.</p>
            <p>This field is populated when the Drug Coverage Code (DRUG_CVRG_STUS_CD) equals “C”.</p>
            <p>This field excludes supplemental drugs, supplemental cost-sharing, over-the-counter drugs, and any non-Part D drugs that are funded by Part C rebates. Finally, this field does not include any amounts paid by the Part D low-income subsidy.</p>
        </description>
    </variable>
    <variable id="DAW_PROD_SLCTN_CD" label="Dispense as Written (DAW) Product Selection Code" length="1" longName="DAW_PROD_SLCTN_CD" shortName="DAWPS_CD" source="PDE" type="CHAR">
        <comment>
            <p>This field does not necessarily represent the way the drug was actually dispensed.</p>
        </comment>
        <description>
            <p>This field indicates the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication.</p>
            <p>Part D plans generally require pharmacies to use generics or the least expensive version of the prescribed drug.</p>
            <p>However, there are times when a prescriber intends for the beneficiary to receive the drug exactly as it is written on the prescription (e.g., to get the brand-name version of a drug). When there are specific instructions from the prescriber, it is indicated in this variable with a value of 1 or greater.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="0">No Product Selection Indicated (may also have missing values)</value>
                <value code="1">Substitution Not Allowed by Prescriber</value>
                <value code="2">Substitution Allowed - Patient Requested That Brand Product Be Dispensed</value>
                <value code="3">Substitution Allowed - Pharmacist Selected Product Dispensed</value>
                <value code="4">Substitution Allowed - Generic Drug Not in Stock</value>
                <value code="5">Substitution Allowed - Brand Drug Dispensed as Generic</value>
                <value code="6">Override</value>
                <value code="7">Substitution Not Allowed - Brand Drug Mandated by Law</value>
                <value code="8">Substitution Allowed - Generic Drug Not Available in Marketplace</value>
                <value code="9">Other</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="DAYS_SUPLY_NUM" label="Days Supply" length="3" longName="DAYS_SUPLY_NUM" shortName="DAYSSPLY" source="PDE" type="NUM" valueFormat="Possible values are 0 – 999.">
        <comment>
            <p>CMS accepts blanks in PDEs where NON-STANDARD FORMAT CODE IS B, X, or P.</p>
        </comment>
        <description>
            <p>This field indicates the number of days' supply of medication dispensed by the pharmacy and consists of the amount the pharmacy enters for the prescription.</p>
        </description>
    </variable>
    <variable id="DOB_DT" label="Patient Date of Birth (DOB)" length="8" longName="DOB_DT" shortName="DOB_DT" source="PDE" type="DATE" valueFormat="Date formatted as CCYYMMDD">
        <comment>
            <p>It is possible that this date may be different than the beneficiary date of birth (BENE_BIRTH_DT) variable that appears on the Master Beneficiary Summary File (MBSF).</p>
        </comment>
        <description>
            <p>Date of birth of the patient as indicated on the event record.</p>
        </description>
    </variable>
    <variable id="DRUG_CVRG_STUS_CD" label="Drug Coverage Status Code" length="1" longName="DRUG_CVRG_STUS_CD" shortName="DRCVSTCD" source="PDE" type="CHAR">
        <description>
            <p>This field indicates whether or not the drug is covered by Medicare Part D.</p>
            <p>The Part D benefit does not cover all FDA-approved drugs. However, plan sponsors can offer an “enhanced” benefit package that covers non-Part D drugs, such as over-the-counter medications.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="C">Covered</value>
                <value code="E">Supplemental drugs (reported by plans that provide Enhanced Alternative coverage)</value>
                <value code="O">Over-the-counter drugs</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="DSPNSNG_STUS_CD" label="Dispensing Status Code" length="1" longName="DSPNSNG_STUS_CD" shortName="DSPNSTCD" source="PDE" type="CHAR">
        <comment>
            <p>This variable has been retired, therefore the field is blank after 2010 service dates.</p>
        </comment>
        <description>
            <p>This field indicates how the pharmacy dispensed the complete quantity of the prescription.</p>
            <p>When the pharmacy partially fills a prescription, this field indicates a partial fill. When the full quantity is dispensed at one time, this field is blank.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="Blank">Not specified or presumably full quantity of prescription</value>
                <value code="P">Partial fill</value>
                <value code="C">Completion of partial fill</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="FILL_NUM" label="Number of drug fills" length="3" longName="FILL_NUM" shortName="FILL_NUM" source="PDE" type="NUM" valueFormat="Possible values are 0 - 99">
        <comment>
            <p>The number of days of a drug that are supplied vary considerably across PDEs.</p>
        </comment>
        <description>
            <p>This field indicates the number fill of the current dispensed supply.</p>
        </description>
    </variable>
    <variable id="FORMULARY_ID" label="Formulary identification number" length="8" longName="FORMULARY_ID" shortName="FORMULARY_ID" source="PDE and CMS HPMS (derived)" type="CHAR" valueFormat="8-digit numeric value">
        <comment>
            <p>The CCW constructs a Formulary Characteristics File from the CMS Approved Formulary Data found in the CMS’s Health Plan Management System (HPMS).</p>
            <p>This variable is first available in 2010. This variable was always encrypted from 2010-2012 to comply with CMS privacy rules.</p>
        </comment>
        <description>
            <p>This variable is the unique identification number assigned to each formulary. Part D plans submit their formularies to CMS and identify the drug products that are covered using the National Library of Medicine’s RxNorm Concept Unique Identifiers (RXCUIs).</p>
            <p>The same formulary may be used by more than one plan benefit package (PBP) within a contract.</p>
        </description>
    </variable>
    <variable id="FRMLRY_RX_ID" label="CCW Formulary drug identifier" length="8" longName="FRMLRY_RX_ID" shortName="FRMLRY_RX_ID" source="PDE and CMS HPMS (derived)" type="CHAR" valueFormat="8-digit number">
        <comment>
            <p>This variable was new in 2010.</p>
            <p>The Formulary Characteristics Files are built from the CMS Approved Formulary Data found in the CMS’ Health Plan Management System (HPMS) where a proxy NDC is assigned to each RXCUI. The proxy NDC for each drug product is mapped to a unique FirstDataBank brand name and proprietary clinical formulation identifier which is then assigned a CCW sequence number (FRMLRY_RX_ID). In order for a PDE record to link to the Formulary Characteristics Files, the drug product on the PDE must map to a FRMLRY_RX_ID in the formulary associated with the plan of record.</p>
            <p>Researchers interested in linking the Utilization Management (UM) variables (tier, step therapy, quantity limits, and prior authorization) to the PDE data will need to link the FORMULARY_ID and FRMLRY_RX_ID to the Formulary Characteristics File to get the UM variables.</p>
        </comment>
        <description>
            <p>This variable is a CCW-created identifier for a drug product that is found in a Part D prescription drug plan's formulary.</p>
            <p>Part D Plans submit their formularies to CMS and identify drug products using the National Library of Medicine RxNorm Concept Unique Identifiers (RXCUIs).</p>
            <p>There can be several drug products submitted that are the same clinical formulation (same ingredients, strength, and dosage form) but different brand names.</p>
            <p>Each RXCUI corresponds to a unique brand name and clinical formulation. The CCW Formulary drug ID is analogous to an RXCUI.</p>
        </description>
    </variable>
    <variable id="GCDF" label="Dosage Form Code" length="2" longName="GCDF" shortName="GCDF" source="First DataBank" type="CHAR" valueFormat="2-digit alpha/numeric code (e.g., CA [capsule], PS [adhesive patch, medicated])">
        <comment>
            <p>The narrative description for this code appears in the dosage form code description variable (called GCDF_DESC).</p>
            <p>In the Formulary file, this variable is populated by matching the drug products on the Part D Plan submitted formulary to FDB. Part D plan sponsors submit the formulary to the CMS Health Plan Management System (HPMS). Plans identify the drug products on their formularies using the National Library of Medicine RxNorm Concept Unique Identifiers (RXCUIs). Each RXCUI corresponds to a unique brand name and clinical formulation (same ingredients, strength, and dosage form).</p>
            <p>In the PDE file, this variable is populated by linking to the proprietary First DataBank MedKnowledge database by matching on the National Drug Code (NDC; variable in the PDE files called the product service identifier PROD_SRVC_ID).</p>
            <p>Additional details regarding the FDB source data are available at: http://www.fdbhealth.com/fdb-medknowledge/</p>
        </comment>
        <description>
            <p>This variable is the dosage form code according to the First DataBank (FDB) reference files. The dosage form describes the physical presentation of a drug, such as tablet, capsule, or liquid. It may also incorporate the delivery and release mechanism of the drug.</p>
            <p>When this variable appears in the Formulary file, it is the FDB dosage form code for a drug product on the formulary.</p>
        </description>
    </variable>
    <variable id="GCDF_DESC" label="Dosage Form Code Description" length="40" longName="GCDF_DESC" shortName="GCDF_DESC" source="First DataBank" type="CHAR" valueFormat="Narrative description (e.g., DROPS or TABLET)">
        <comment>
            <p>The accompanying FDB code for this description appears in the dosage form code variable (called GCDF).</p>
            <p>In the Formulary file, this variable is populated by matching the drug products on the Part D Plan submitted formulary to FDB. Part D plan sponsors submit the formulary to the CMS Health Plan Management System (HPMS). Plans identify the drug products on their formularies using the National Library of Medicine RxNorm Concept Unique Identifiers (RXCUIs). Each RXCUI corresponds to a unique brand name and clinical formulation (same ingredients, strength, and dosage form).</p>
            <p>In the PDE file, this variable is populated by linking to the proprietary First DataBank MedKnowledge database by matching on the National Drug Code (NDC; variable in the PDE files called the product service identifier PROD_SRVC_ID).</p>
            <p>Additional details regarding the FDB source data are available at: http://www.fdbhealth.com/fdb-medknowledge/</p>
        </comment>
        <description>
            <p>This variable describes the dosage form of a clinical formulation, according to the First DataBank (FDB) reference files. The dosage form is the physical presentation of a drug, such as tablet, capsule, or liquid. It may also incorporate the delivery and release mechanism of the drug.</p>
            <p>When this variable appears in the Formulary file, it is the FDB dosage form code description for a drug product on the formulary.</p>
        </description>
    </variable>
    <variable id="GDC_ABV_OOPT_AMT" label="Gross Drug Cost Above Part D Out-of-Pocket Threshold (GDCA)" length="10" longName="GDC_ABV_OOPT_AMT" shortName="GDCAOOPT" source="PDE" type="NUM">
        <comment>
            <p>See the GDC_BLW_OOPT_AMT variable for the portion of the gross drug cost that was not covered by Part D’s catastrophic coverage.</p>
        </comment>
        <description>
            <p>This variable is the portion of the gross drug cost for the prescription drug fill that was covered by Part D’s catastrophic coverage.</p>
            <p>Under Part D, a beneficiary qualifies for catastrophic coverage when his/her true out-of-pocket (TrOOP) costs reach a specific dollar threshold (for example, the threshold was $4,550 in 2010). For prescriptions that were filled when a beneficiary was below the out-of-pocket threshold (OOPT), this field will contain a zero dollar amount. For prescriptions above the OOPT, this field will contain a positive dollar value. If a prescription crosses the threshold, then the portion of the gross drug cost that is above the threshold will appear in this field.</p>
        </description>
    </variable>
    <variable id="GDC_BLW_OOPT_AMT" label="Gross Drug Cost Below Part D Out-of-Pocket Threshold (GDCB)" length="10" longName="GDC_BLW_OOPT_AMT" shortName="GDCBOOPT" source="PDE" type="NUM">
        <comment>
            <p>See the GDC_ABV_OOPT_AMT variable for the portion of the gross drug cost that was covered by Part D’s catastrophic coverage.</p>
        </comment>
        <description>
            <p>This variable is the portion of the gross drug cost for the prescription drug fill that was not covered by Part D’s catastrophic coverage.</p>
            <p>Under Part D, a beneficiary qualifies for catastrophic coverage when his/her true out-of-pocket (TrOOP) costs reach a specific dollar threshold (for example, the threshold was $4,550 in 2010). For prescriptions that were filled when a beneficiary was below the out-of-pocket threshold (OOPT), this field will contain a positive dollar value. For prescriptions above the OOPT, this field will contain a zero dollar amount. If a prescription crosses the threshold, then the portion of the gross drug cost that is below the threshold will appear in this field.</p>
        </description>
    </variable>
    <variable id="GNDR_CD" label="Patient Gender" length="1" longName="GNDR_CD" shortName="GNDR_CD" source="PDE" type="CHAR">
        <description>
            <p>Gender of the patient as indicated on the event record.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="Blank">Unknown</value>
                <value code="1">Male</value>
                <value code="2">Female</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="GNN" label="Generic Name" length="30" longName="GNN" shortName="GNN" source="First DataBank" type="CHAR" valueFormat="text description of drug (e.g., RISEDRONATE SODIUM, MEMANTINE HCL)">
        <comment>
            <p>FDB uses the chemical name when the USAN name is not available. For multi-ingredient products, abbreviations may be used (e.g., HCTZ [Hydrochlorothiazide] and PP [Phenylpropanolamine]).</p>
            <p>In the Formulary file, this variable is populated by matching the drug products on the Part D Plan submitted formulary to FDB. Part D plan sponsors submit the formulary to the CMS Health Plan Management System (HPMS). Plans identify the drug products on their formularies using the National Library of Medicine RxNorm Concept Unique Identifiers (RXCUIs). Each RXCUI corresponds to a unique brand name and clinical formulation (same ingredients, strength, and dosage form).</p>
            <p>In the PDE file, this variable is populated by linking to the proprietary First DataBank MedKnowledge database by matching on the National Drug Code (NDC; variable in the PDE files called the product service identifier PROD_SRVC_ID).</p>
            <p>Additional details regarding the FDB source data are available at: http://www.fdbhealth.com/fdb-medknowledge/</p>
        </comment>
        <description>
            <p>This is the generic name of the dispensed PDE, according to the First DataBank (FDB) reference files. It is the drug ingredient name adopted by United States Adopted Names (USAN).</p>
            <p>When this variable appears in the Formulary file, it is the FDB generic name for a drug product on the formulary.</p>
        </description>
    </variable>
    <variable id="LICS_AMT" label="Amount paid for the PDE by Part D low income subsidy" length="10" longName="LICS_AMT" shortName="LICS_AMT" source="PDE" type="NUM">
        <comment>
            <p>This variable comes directly from the original PDE.</p>
        </comment>
        <description>
            <p>This is the amount of cost sharing for the drug that was paid by the Part D low-income subsidy (LICS). This field contains plan-reported amounts per drug event; CMS uses this information to reconcile the prospective payments it makes to Part D plans for expected low-income cost sharing with the actual amounts incurred by the plans.</p>
        </description>
    </variable>
    <variable id="NCPDP_ID" label="NCPDP Pharmacy identifier" length="7" longName="NCPDP_ID" shortName="NCPDP_ID" source="PDE and NCDPD dataQ™" type="CHAR" valueFormat="Null">
        <comment>
            <p>This variable was new in 2014. The NCPDP_ID is used in place of the CCW_PHARM_ID in the Part D Pharmacy Characteristics File.</p>
            <p>Researchers who received CCW data from 2006-2013 and wish to identify the NCPDP_ID associated with the CCW_PHARM_ID may request the "Pharmacy Bridge File", which is designed for this purpose.</p>
            <p>Investigators who wish to obtain the CCW Pharmacy Characteristics files must choose between obtaining the pharmacy IDs on the PDE (variable called the service provider ID [SRVC_PRVDR_ID]), or the proprietary NCPDP_ID that will allow linkage between the PDE and Pharmacy Characteristics Files.</p>
            <p>The NCPDP_ID variable is populated by linking the service provider identification number (SRVC_PRVDR_ID) from the source PDE to the proprietary National Council for Prescription Drug Programs (NCPDP) dataQ™ Database. The variable is populated for every PDE that can be linked to the NCPDP pharmacy data for that year, and will occasionally be null if there was no conclusive link between the service provider identification number in the source PDE data and the provider identification numbers in the NCPDP pharmacy data. Within the NCPDP database, this ID used to be called the NABP Number. NCPDP also enumerates licensed Alternate Dispensing Sites and Durable Medical Equipment (DME) Providers.</p>
            <p>This variable usually represents a unique pharmacy entity, which historically was a retail store. However, as the pharmacy industry has evolved, some retail stores have added other lines of business, such as filling prescriptions for long-term care facilities. In these cases, the pharmacy can ask NCPDP to issue them more than one identification number to keep the billing separate for their multiple lines of business.</p>
            <p>Additional details regarding the NCPDP source data are available at: https://www.ncpdpdataq.org/dataQInfo/pages/dataQFiles.htm.</p>
        </comment>
        <description>
            <p>This is the unique identification number assigned by the National Council for Prescription Drug Programs (NCPDP) to every licensed pharmacy in the United States and its territories.</p>
            <p>This field also enables linkage between pharmacies in the Part D Event (PDE) File and the CCW Pharmacy Characteristics File for 2014+.</p>
        </description>
    </variable>
    <variable id="NCVRD_PLAN_PD_AMT" label="Amount paid by Part D plan for the PDE (drug is not covered by Part D)" length="10" longName="NCVRD_PLAN_PD_AMT" shortName="NPP_AMT" source="PDE" type="NUM">
        <comment>
            <p>This variable comes directly from the original PDE.</p>
        </comment>
        <description>
            <p>This is the net amount paid by the Part D plan for benefits beyond the standard Part D benefit.</p>
            <p>Medicare requires Part D plans to cover certain drugs, but some plans may offer benefits that are more generous than the standard benefit by covering drugs that Part D does not cover. This field is populated when the Drug Coverage Code (variable called DRUG_CVRG_STUS_CD) does not equal “C”. This variable is the net amount the plan has paid for all over-the-counter drugs, enhanced alternative drugs, and enhanced alternative cost-sharing amounts.</p>
        </description>
    </variable>
    <variable id="NSTD_FRMT_CD" label="Non-Standard Format Code" length="1" longName="NSTD_FRMT_CD" shortName="NSTFMTCD" source="PDE" type="CHAR">
        <description>
            <p>This data element is used by CMS to identify PDE records that are compiled from non-standard sources.</p>
            <p>The National Council for Prescription Drug Program (NCPDP) is the standard format in which plans receive data from pharmacies.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="X">X12 837</value>
                <value code="B">Beneficiary submitted claim</value>
                <value code="C">Coordination of Benefits</value>
                <value code="P">Paper claim from provider</value>
                <value code="Blank">NCPDP electronic format</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="OTHR_TROOP_AMT" label="Other True Out-of-Pocket (TrOOP) Amount" length="10" longName="OTHR_TROOP_AMT" shortName="OTHTROOP" source="PDE" type="NUM">
        <description>
            <p>This is the amount of any payment made by other third-party payers that reduces the beneficiary’s liability for the PDE and counts towards Part D’s true out-of-pocket (TrOOP) requirement. Two examples are payments by qualified state pharmacy assistance programs or charities. This variable does not include amounts covered by the Part D low-income subsidy.</p>
        </description>
    </variable>
    <variable id="PD_DT" label="Paid Date" length="8" longName="PD_DT" shortName="PD_DT" source="PDE" type="DATE" valueFormat="Date formatted as CCYYMMDD">
        <comment>
            <p>This is an optional field.</p>
        </comment>
        <description>
            <p>The date on which the plan originally paid the pharmacy for the prescription drug.</p>
        </description>
    </variable>
    <variable id="PDE_ID" label="CCW Encrypted Part D Event Number" length="15" longName="PDE_ID" shortName="PDE_ID" source="CCW" type="CHAR">
        <description>
            <p>Identifies a unique Part D event for a beneficiary.</p>
        </description>
    </variable>
    <variable id="PDE_PRSCRBR_ID_FRMT_CD" label="PDE Prescriber ID Format Code" length="1" longName="PDE_PRSCRBR_ID_FRMT_CD" shortName="PDE_PRSCRBR_ID_FRMT_CD" source="PDE (derived)" type="CHAR">
        <comment>
            <p>This variable may have ascribed a different format to the prescriber identifier than what was reported in the prescriber id qualifier code (variable called PRSCRBR_ID_QLFYR_CD), which is submitted on the original PDE.</p>
            <p>The PDE_PRSCRBR_ID_FRMT_CD was retired after 2013 since it was designed to provide information regarding the type of prescriber identifier that appeared on the PDE, since the CCW was not allowed to release the actual prescriber identifier (PRSCRBR_ID).</p>
        </comment>
        <description>
            <p>This variable was created by CCW to describe whether the Prescriber ID on the source PDE (variable called PRSCRBR_ID) was an NPI, DEA, or UPIN format based on the length of the Prescriber ID and the combination of alpha and numeric characters.</p>
            <p>This variable was only available 2006 - 2013.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="N">PDE Prescriber ID has an NPI format: 10 numeric characters with the first character a '1' or a '2'</value>
                <value code="D">PDE Prescriber ID has a DEA format: 9 alpha-numeric characters with the first two characters alpha and the last seven numeric</value>
                <value code="U">PDE Prescriber ID has a UPIN format: 6 alpha-numeric characters with the first one alpha and the remaining numeric</value>
                <value code="X">PDE Prescriber ID is none of the above formats. PDE Prescriber ID could be a valid State License number, an invalid prescriber identifier, or a missing Prescriber ID</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="PHRMCY_SRVC_TYPE_CD" label="Pharmacy service type code" length="2" longName="PHRMCY_SRVC_TYPE_CD" source="PDE" type="CHAR">
        <comment>
            <p>This variable was new in 2013 and required for all PDEs beginning on February 28, 2013.</p>
        </comment>
        <description>
            <p>The type of pharmacy used. This variable indicates the type of pharmacy that dispensed the prescription, as recorded on the PDE.</p>
            <p>CMS requires Part D plans to maintain pharmacy networks that are sufficient to ensure access to Medicare beneficiaries – including retail, home infusion, and long-term care pharmacies. Plan sponsors have contracts with pharmacies to provide “in-network” services.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="01">Community/retail pharmacy</value>
                <value code="02">Compounding pharmacy</value>
                <value code="03">Home infusion therapy provider</value>
                <value code="04">Institutional pharmacy</value>
                <value code="05">Long-term care pharmacy</value>
                <value code="06">Mail order pharmacy</value>
                <value code="07">Managed care organization (MCO) pharmacy</value>
                <value code="08">Specialty care pharmacy</value>
                <value code="99">Other</value>
                <value code="Null">Pharmacy is not in any other category above</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="PLAN_CNTRCT_REC_ID" label="Plan Contract ID" length="5" longName="PLAN_CNTRCT_REC_ID" shortName="PLNCNTRC" source="PDE" type="CHAR">
        <comment>
            <p>For 2006 - 2012, this variable was always encrypted to comply with CMS privacy rules.</p>
            <p>You need to know both the Part D contract number and plan benefit package number (PLAN_PBP_REC_NUM) in order to identify the specific plan in which a beneficiary was enrolled.</p>
        </comment>
        <description>
            <p>This variable is the unique Part D contract identifier for the beneficiary’s Part D plan of record for the year. CMS assigns an identifier to each contract that a Part D plan has with CMS.</p>
            <p>If the beneficiary was enrolled in more than one plan during the year, this is the contract number for the Part D plan in which the beneficiary was enrolled at the end of the year.</p>
            <p>The first character of the plan contract ID is a letter representing the type of plan.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <description>
                    <p>5-digit alpha/numeric value. First digit is one of the following -</p>
                </description>
                <value code="H">Managed Care Organizations other than Regional PPO</value>
                <value code="R">Regional preferred provider organization (PPO)</value>
                <value code="S">Stand-alone prescription drug plan (PDP)</value>
                <value code="E">Employer direct plan (starting January 2007)</value>
                <value code="X">Limited Income Newly Eligible Transition plan (LI NET, starting July 2009)</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="PLAN_PBP_REC_NUM" label="Plan Benefit Package ID" length="3" longName="PLAN_PBP_REC_NUM" shortName="PLNPBPRC" source="PDE" type="CHAR" valueFormat="3-digit numeric value">
        <comment>
            <p>For 2006 - 2012, this variable was always encrypted to comply with CMS privacy rules.</p>
            <p>You need to know both the Part D contract number (PLAN_CNTRCT_REC_ID) and plan benefit package number in order to identify the specific plan in which a beneficiary was enrolled.</p>
        </comment>
        <description>
            <p>This variable is the unique plan benefit package (PBP) identifier for the beneficiary’s Part D plan of record for the year. CMS assigns an identifier to each PBP within a contract that a Part D plan sponsor has with CMS.</p>
            <p>If the beneficiary was enrolled in more than one plan during the year, this is the plan benefit package identifier for the plan in which the beneficiary was enrolled at the end of the year.</p>
        </description>
    </variable>
    <variable id="PLRO_AMT" label="Reduction in patient liability due to payments by other payers (PLRO)" length="10" longName="PLRO_AMT" shortName="PLRO_AMT" source="PDE" type="NUM">
        <comment>
            <p>This variable comes directly from the original PDE.</p>
        </comment>
        <description>
            <p>This is the amount of any payment by other third-party payers that reduces the beneficiary’s liability for the PDE but does not count towards Part D’s true out-of-pocket (TrOOP) requirement. Examples include payments by group health plans, worker's compensation, and governmental programs like the Veterans Administration and TRICARE.</p>
        </description>
    </variable>
    <variable id="PRCNG_EXCPTN_CD" label="Pricing Exception Code" length="1" longName="PRCNG_EXCPTN_CD" shortName="PRCGEXCD" source="PDE" type="CHAR">
        <description>
            <p>This variable indicates if the PDE was processed by the Part D plan using pricing rules that differ from the plan's negotiated price. Most PDEs have missing values, indicating that they were obtained from in-network pharmacies.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="M">Medicare is a secondary payer (MSP)</value>
                <value code="O">Out of network pharmacy</value>
                <value code="Blank">In-network pharmacy</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="PRIOR_AUTHORIZATION_YN" label="Prior Authorization Indicator" length="2" longName="PRIOR_AUTHORIZATION_YN" shortName="PRAUTHYN" source="PDE and Plan Characteristics (derived)" type="CHAR">
        <comment>
            <p>Part D plan sponsors submit the pricing, tiers, and formularies for their plan benefit packages to CMS via the Health Plan Management System (HPMS).</p>
            <p>This includes information on which drugs are subject to prior authorization, which means that a physician must get the plan’s approval in advance before prescribing the drug. The CCW creates this variable based on the beneficiary’s plan of record, which is identified using the Part D contract and plan benefit package of record (the PLAN_CNTRCT_REC_ID and PLAN_PBP_REC_NUM variables). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be an accurate reflection of whether the PDE was subject to prior authorization.</p>
        </comment>
        <description>
            <p>This is a CCW-derived field that indicates whether the prescription was subject to prior authorization, according to the benefit structure and formulary for the beneficiary’s plan.</p>
            <p>Starting in 2010, this variable included in the Formulary file (rather than the PDE file).</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="1">Prior authorization required</value>
                <value code="0">Prior authorization not required Null</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="PROD_SRVC_ID" label="Product Service ID" length="19" longName="PROD_SRVC_ID" shortName="PRDSRVID" source="PDE" type="CHAR">
        <comment>
            <p>The NDC is reported in an 11-digit format, which is divided into three sections. The first five digits indicate the manufacturer or the labeler; the next four digits indicate the ingredient, strength, dosage form and route of administration; and the last two digits indicate the packaging.</p>
            <p>The FDA assigns the manufacturer portion of the code; the manufacturer supplies the rest.</p>
            <p>NDC code in the following format: MMMMMDDDDPP followed by 8 spaces.</p>
            <p>CMS rejects the following codes: 99999999999, 99999999992, 99999999993, 99999999994, 99999999995 and 99999999996.</p>
        </comment>
        <description>
            <p>This field identifies the dispensed drug product using a National Drug Code (NDC).</p>
            <p>The NDC is reported in NDC11 format. In instances where a pharmacy formulates a compound containing multiple NDC drugs, the NDC of the most expensive drug is used.</p>
        </description>
    </variable>
    <variable id="PRSCRBR_ID" label="Prescriber Identification Number" length="15" longName="PRSCRBR_ID" shortName="PRSCRBR_ID" source="PDE" type="CHAR" valueFormat="Up to 15 positive integers">
        <comment>
            <p>Historically, a single individual prescriber might have had more than one type of identifier, and the PDEs that he/she prescribed may have more than one PRSCRBR_ID (e.g., the NPI could have appeared on some PDEs and the DEA number on others). The PRSCRBR_ID usually represents a unique individual prescriber (i.e., a prescribing provider), but can occasionally represent an entity or organization (e.g., a clinic or specialized unit of a hospital).</p>
            <p>From 2006 -2013, when CMS privacy restrictions prohibited release of this variable, the CCW created a unique CCW prescriber identifier by cross walking all of the possible identifiers for each prescriber and assigning a CCW_PRSCRBR_ID to represent an individual medical practitioner. This allowed PDE records that had the same prescriber but used a combination of different identifiers to be assigned the same identifier in the CCW files.</p>
            <p>From 2006 - 2013, the CCW_PRSCRBR_ID enabled linkage to the CCW Prescriber Characteristics File. For current years, the PRSCRBR_ID will link to the Prescriber Characteristics File. For 2006-2013, the CCW_PRSCRBR_ID may be obtained instead of (but not in addition to) the PRSCRBR_ID. The CCW_PRSCRBR_ID was retired after 2013.</p>
        </comment>
        <description>
            <p>This variable contains the prescriber identification number as reported by the Part D sponsor on the PDE record submitted to CMS.</p>
            <p>Historically, this could be an NPI, DEA identification number, or UPIN. Since NPIs are now required by CMS (after April 2013), they appear most frequently (2009 forward).</p>
            <p>The type of prescriber identifier used is documented in the PRSCRBR_ID_QLFYR_CD variable.</p>
            <p>Starting with 2014 data, the PRSCRBR_ID can be used to link to the NPI variable in the Prescriber Characteristics File.</p>
        </description>
    </variable>
    <variable id="PRSCRBR_ID_QLFYR_CD" label="Prescriber identification number qualifier code" length="2" longName="PRSCRBR_ID_QLFYR_CD" shortName="PRSCRBR_ID_QLFYR_CD" source="PDE" type="CHAR">
        <comment>
            <p>This variable may only be obtained if the investigator receives the prescriber identifier (PRSCRBR_ID instead of the unique CCW prescriber identifier [variable called CCW_PRSCRBR_ID], which was retired after 2013). The CCW creates the CCW_PRSCRBR_ID from the prescriber identifier (PRSCRBR_ID) variable on the original PDE.</p>
            <p>This field is not validated and does not always reliably describe the identification numbers found in the prescriber identifier field (PRSCRBR_ID).</p>
            <p>Investigators interested in linking the prescriber identifiers to cross-reference databases may find it helpful to know the type of variable that appears in this data field. The CCW has found it more accurate to perform testing on the PRSCRBR_ID variable itself to determine the variable type, rather than relying on the information in this field (note that for 2006-2013, CCW created a variable called PDE_PRSCRBR_ID_FRMT_CD to examine the format). The CCW methodology consists of examining the format and structure of the PRSCRBR_ID to determine whether the value appears to conform to the various types of ID.</p>
            <p>The formats of these variables are: • NPI format -- 10 numeric characters starting with ‘1’ or ‘2’ • DEA format -- 9 alpha-numeric characters with the first two being alpha and the last 7 being numeric • UPIN format -- 6 alpha-numeric characters with the first being alpha and the remaining 5 being numeric (note: the UPIN is a legacy identifier and should not be seen often in the current PDEs) • State license numbers – formats are highly variable A fair number of values in this data field that are not NPIs or DEAs may be invalid.</p>
        </comment>
        <description>
            <p>This variable contains information regarding the type of prescriber identification number that was submitted on the original PDE data, as reported by the Part D sponsor on the PDE record submitted to CMS.</p>
            <p>Historically, this identifier could be an NPI, DEA identification number, UPIN, or state license number. After April 2013, it is an NPI.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="01">National Provider Identifier (NPI)</value>
                <value code="06">Unique Physician Identification Number (UPIN)</value>
                <value code="08">State license number</value>
                <value code="12">Drug Enforcement Administration (DEA) number Null/missing</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="PTNT_PAY_AMT" label="Amount Paid by Patient" length="10" longName="PTNT_PAY_AMT" shortName="PTPAYAMT" source="PDE" type="NUM">
        <comment>
            <p>Three other variables measure payments that are made on behalf of the beneficiary and reduce the amount that he/she would normally have to pay for the PDE: LICS_AMT (amount paid by Part D low-income subsidy), OTHER_TROOP_AMT (other third-party payments that count towards the TrOOP amount), and PLRO_AMT (other third-party payments that do not count towards the TrOOP amount).</p>
            <p>If you want to know the beneficiary’s total liability for the drug (i.e., the amount that the Part D plan did not cover), you must sum this variable and the 3 variables listed above.</p>
        </comment>
        <description>
            <p>This variable is the dollar amount that the beneficiary paid for the PDE without being reimbursed by a third party.</p>
            <p>The amount includes all copayments, coinsurance, deductible, or other patient payment amounts, and comes directly from the source PDE. This amount contributes to a beneficiary's true out-of-pocket (TrOOP) costs, but only if it is for a Part D-covered drug (i.e., spending on non-covered drugs does not count toward the TrOOP amount).</p>
        </description>
    </variable>
    <variable id="PTNT_RSDNC_CD" label="Patient Residence Code" length="2" longName="PTNT_RSDNC_CD" source="PDE" type="CHAR">
        <comment>
            <p>CMS requires Part D plans to maintain pharmacy networks that are sufficient to ensure convenient access to Medicare beneficiaries – including retail, home infusion, and long-term care pharmacies. This variable is designed to help CMS and plan sponsors monitor beneficiary access to a range of “in-network” pharmacies.</p>
            <p>This variable was new in 2013 and required for all PDEs beginning on February 28, 2013.</p>
            <p>Note that the location indicated by this variable may not correspond with other information regarding beneficiary residence – such as Medicare Part A or B claims or Minimum Data Set (MDS) assessment information.</p>
        </comment>
        <description>
            <p>This variable indicates where the beneficiary lived when the prescription was filled, as reported on the PDE record.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="00">Not specified, other patient residence not identified below</value>
                <value code="01">Home</value>
                <value code="02">Skilled Nursing Facility</value>
                <value code="03">Nursing facility (long-term care facility)</value>
                <value code="04">Assisted living facility</value>
                <value code="05">Custodial Care Facility (residential but not medical care)</value>
                <value code="06">Group home (e.g., congregate residential foster care)</value>
                <value code="07">Inpatient Psychiatric Facility</value>
                <value code="08">Psychiatric Facility – Partial Hospitalization</value>
                <value code="09">Intermediate care facility for the mentally retarded (ICF/MR)</value>
                <value code="10">Residential Substance Abuse Treatment Facility</value>
                <value code="11">Hospice</value>
                <value code="12">Psychiatric Residential Treatment Facility</value>
                <value code="13">Comprehensive Inpatient Rehabilitation Facility</value>
                <value code="14">Homeless Shelter</value>
                <value code="15">Correctional Institution</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="QTY_DSPNSD_NUM" label="Quantity Dispensed" length="12" longName="QTY_DSPNSD_NUM" shortName="QTYDSPNS" source="PDE" type="NUM">
        <comment>
            <p>The values for this field are highly variable and depend on the form of the drug that was dispensed (e.g., liquids or tablets).</p>
        </comment>
        <description>
            <p>This field indicates the number of units, grams, milliliters, or other quantity dispensed in the current drug event.</p>
            <p>If the PDE was for a compounded item, the quantity dispensed is the total of all ingredients. If the PDE was for a partial fill, the quantity dispensed is the total amount prescribed, not the portion covered by the partial fill.</p>
        </description>
    </variable>
    <variable id="QUANTITY_LIMIT_YN" label="Quantity Limit Indicator" length="2" longName="QTY_DSPNSD_NUM" shortName="QTYDSPNS" source="PDE and Plan Characteristics (derived)" type="CHAR">
        <comment>
            <p>Part D plan sponsors submit the pricing, tiers, and formularies for their plan benefit packages to CMS via the Health Plan Management System (HPMS).</p>
            <p>This includes information on which drugs are subject to quantity limits, which restrict the amount that a beneficiary may receive within a certain time period.</p>
            <p>The CCW creates this variable based on the beneficiary’s plan of record, which is identified using the Part D contract and plan benefit package of record (the PLAN_CNTRCT_REC_ID and PLAN_PBP_REC_NUM variables). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be an accurate reflection of whether the PDE was subject to quantity limits.</p>
        </comment>
        <description>
            <p>This is a CCW-derived field that indicates whether the prescription was subject to quantity limits, according to the benefit structure and formulary for the beneficiary’s plan.</p>
            <p>Starting in 2010, this variable is included in the Formulary file (rather than the PDE file).</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="1">Quantity limits apply</value>
                <value code="0">Quantity limits do not apply Null</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="RPTD_GAP_DSCNT_NUM" label="Gap Discount Amount" length="10" longName="RPTD_GAP_DSCNT_NUM" shortName="GAPDSCNT" source="PDE" type="NUM">
        <comment>
            <p>This variable is new in 2012.</p>
        </comment>
        <description>
            <p>This variable indicates the amount of the discount provided by the drug’s manufacturer under the Medicare Coverage Gap Discount Program, as calculated by CMS based on data reported in the PDE.</p>
        </description>
    </variable>
    <variable id="RX_ORGN_CD" label="Prescription Origination Code" length="1" longName="RX_ORGN_CD" shortName="RX_ORGN_CD" source="PDE" type="CHAR">
        <comment>
            <p>This variable was new in 2010.</p>
        </comment>
        <description>
            <p>This variable indicates whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="Null">Unknown</value>
                <value code="0">Not specified</value>
                <value code="1">Written</value>
                <value code="2">Telephone</value>
                <value code="3">Electronic</value>
                <value code="4">Facsimile</value>
                <value code="5">Pharmacy</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="RX_SRVC_RFRNC_NUM" label="RX Service Reference Number" length="12" longName="RX_SRVC_RFRNC_NUM" shortName="SRVRFNUM" source="PDE" type="NUM">
        <comment>
            <p>Field length expanded from 10 to 12 in 2011.</p>
        </comment>
        <description>
            <p>This field contains the prescription reference number assigned by the pharmacy at the time the prescription is filled.</p>
        </description>
    </variable>
    <variable id="SRVC_DT" label="RX Service Date" length="8" longName="SRVC_DT" shortName="SRVC_DT" source="PDE" type="DATE" valueFormat="Date formatted as CCYYMMDD">
        <description>
            <p>This field contains the date on which the prescription was filled.</p>
        </description>
    </variable>
    <variable id="SRVC_PRVDR_ID" label="Service provider identification number" length="15" longName="SRVC_PRVDR_ID" shortName="SRVC_PRVDR_ID" source="PDE" type="CHAR" valueFormat="Up to 10-digit numeric value (example - 1235247610)">
        <comment>
            <p>This variable can be requested if the CCW Pharmacy Characteristics file is not required.</p>
            <p>Note that from 2006-2013, the CCW created a unique CCW pharmacy identifier (variable called CCW_PHARM_ID) from this pharmacy identifier variable on the PDE by cross walking all of the possible identifiers for a unique pharmacy and assigning a CCW_PHARM_ID to represent an individual pharmacy entity.</p>
            <p>The CCW_PHARM_ID may be obtained instead of (but not in addition to) the SRVC_PRVR_ID; starting with 2014, the CCW_PHARM_ID is replaced with the NCPDP_ID (and may not be obtained with the SRVC_PRVDR_ID).</p>
            <p>Information regarding the information the type of pharmacy identifier that was submitted on the original PDE data is documented in the SRVC_PRVDR_ID_QLFYR_CD variable.</p>
        </comment>
        <description>
            <p>This variable is the identification number for the pharmacy or physicians' office that dispensed the drug, as reported by the Part D sponsor on the PDE record submitted to CMS.</p>
        </description>
    </variable>
    <variable id="SRVC_PRVDR_ID_QLFYR_CD" label="Service provider identification number qualifier code" length="2" longName="SRVC_PRVDR_ID_QLFYR_CD" shortName="SRVC_PRVDR_ID_QLFYR_CD" source="PDE" type="CHAR">
        <comment>
            <p>This variable may only be obtained if the investigator receives the SRVC_PRVDR_ID (instead of the CCW_PHARM_ID/NCPDP_ID).</p>
        </comment>
        <description>
            <p>This variable indicates the type of pharmacy provider identifier that was used in the SRVC_PRVDR_ID field, as reported by the Part D sponsor on the PDE record submitted to CMS.</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="01">National Provider Identifier (NPI)</value>
                <value code="06">Unique Physician Identification Number (UPIN)</value>
                <value code="07">National Council for Prescription Drug Programs (NCPDP) provider identifier</value>
                <value code="08">State license number</value>
                <value code="11">Federal tax number</value>
                <value code="99">Other Null/missing</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="STEP" label="Maximum Step Number" length="2" longName="STEP" shortName="STEP" source="PDE and Plan Characteristics (derived)" type="CHAR" valueFormat="Null">
        <comment>
            <p>Part D plan sponsors submit the pricing, tiers, and formularies for their plan benefit packages to CMS via the Health Plan Management System (HPMS).</p>
            <p>This includes information on which drugs are subject to step therapy, which requires a beneficiary to first try one or more other medications in the same therapeutic class. The CCW creates this variable based on the beneficiary’s plan of record, which is identified using the Part D contract and plan benefit package of record (the PLAN_CNTRCT_REC_ID and PLAN_PBP_REC_NUM variables). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be an accurate reflection of whether the PDE was part of a step therapy protocol.</p>
        </comment>
        <description>
            <p>This is a CCW-derived field that indicates whether the prescription was subject to a step therapy protocol, according to the benefit structure and formulary for the beneficiary’s plan. If a product is part of two different step therapy protocols, this field is populated with the maximum step value for the product. If the value is greater than 1, then the beneficiary’s plan imposed some type of step therapy requirement, and the value indicates the number of steps or therapy trials needed before becoming eligible for the current drug.</p>
            <p>Starting in 2010, this variable is included in the Formulary file (rather than the PDE file).</p>
        </description>
        <valueGroups>
            <valueGroup>
                <description>
                    <p>Null</p>
                </description>
                <value code="1-4">The maximum step on the plan's formulary associated with the drug on the PDE.</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="STR" label="Drug Strength Description" length="10" longName="STR" shortName="STR" source="First DataBank" type="CHAR" valueFormat="10-digit alpha/numeric value (e.g., 25MG, 1:10000, or 10MG/100ML)">
        <comment>
            <p>Description of drug potency may be expressed in units of grams, milligrams, percentage, and other terms.</p>
            <p>In the Formulary file, this variable is populated by matching the drug products on the Part D Plan submitted formulary to FDB. Part D plan sponsors submit the formulary to the CMS Health Plan Management System (HPMS). Plans identify the drug products on their formularies using the National Library of Medicine RxNorm Concept Unique Identifiers (RXCUIs). Each RXCUI corresponds to a unique brand name and clinical formulation (same ingredients, strength, and dosage form).</p>
            <p>In the PDE file, this variable is populated by linking to the proprietary First DataBank MedKnowledge database by matching on the National Drug Code (NDC; variable in the PDE files called the product service identifier PROD_SRVC_ID).</p>
            <p>Additional details regarding the FDB source data are available at: http://www.fdbhealth.com/fdb-medknowledge/</p>
        </comment>
        <description>
            <p>This variable is the strength or potency of the drug product as dispensed, according to the First DataBank (FDB) reference files.</p>
            <p>When this variable appears in the Formulary file, it is the FDB drug strength for a drug product on the formulary.</p>
        </description>
    </variable>
    <variable id="SUBMSN_CLR_CD" label="Submission clarification code" length="2" longName="SUBMSN_CLR_CD" source="PDE" type="CHAR">
        <comment>
            <p>CMS requires Part D plans to have drug utilization management programs to encourage compliance with the formulary; this variable is designed to make it easier to monitor how well LTC pharmacies comply with formularies by making it easier to aggregate LTC prescriptions into 31-day equivalent prescriptions and thus compare pricing.</p>
            <p>Note that this variable is different than the days supply of the medication on the PDE (the DAYS_SUPLY_NUM variable).</p>
            <p>This variable was new in 2013 and required for all PDEs beginning on February 28, 2013.</p>
        </comment>
        <description>
            <p>For beneficiaries living in long-term care (LTC) facilities, this variable indicates how many days’ supply of the medication was dispensed by the long-term care pharmacy and provides some details about the dispensing event.</p>
            <p>This variable is only populated when beneficiary lives in an LTC facility (i.e., when the PTNT_RSDNC_CD variable equals 03).</p>
        </description>
        <valueGroups>
            <valueGroup>
                <value code="00">(Unknown value – rarely populated)</value>
                <value code="05">Therapy change. Physician determined that a change in therapy was required – either the medication was used faster than expected, or a different dosage form is needed.</value>
                <value code="07">Emergency supply of non-formulary drugs (or formulary drugs which typically require step therapy or prior authorization). Medication has been determined by the physician to be medically necessary.</value>
                <value code="08">Process compound for approved ingredients</value>
                <value code="14">LTC leave of absence – short fill required for take-home use</value>
                <value code="16">LTC emergency box (e box) /automated dispensing machine</value>
                <value code="17">LTC emergency supply remainder (remainder of drug from the emergency supply)</value>
                <value code="18">LTC patient admit/readmission indicator. This status required new dispensing of medication.</value>
                <value code="19">Split billing. The quantity dispensed is the remainder billed to a subsequent payer after Medicare Part A benefits expired (partial payment under Part A).</value>
                <value code="21">LTC dispensing rule for &lt;=14 day supply is not applicable due to CMS exclusion or the fact that the manufacturer’s packaging does not allow for special dispensing</value>
                <value code="22">LTC dispensing, 7-day supply</value>
                <value code="23">LTC dispensing, 4-day supply</value>
                <value code="24">LTC dispensing, 3-day supply</value>
                <value code="25">LTC dispensing, 2-day supply</value>
                <value code="26">LTC dispensing, 1-day supply</value>
                <value code="27">LTC dispensing, 4-day supply, then 3-day supply</value>
                <value code="28">LTC dispensing, 2-day supply, then 2-day supply, then 3-day supply</value>
                <value code="29">LTC dispensing, daily during the week then multiple days (3) for weekend</value>
                <value code="30">LTC dispensing, per shift (multiple medication passes)</value>
                <value code="31">LTC dispensing, per medication pass</value>
                <value code="32">LTC dispensing, PRN on demand</value>
                <value code="33">LTC dispensing, other &lt;=7 day cycle</value>
                <value code="34">LTC dispensing, 14-day supply</value>
                <value code="35">LTC dispensing, other 8-14 day dispensing not listed above</value>
                <value code="36">LTC dispensing, outside short cycle, determined to be Part D after originally submitted to another payer</value>
                <value code="42">The prescriber ID submitted has been validated and is active (rarely populated)</value>
                <value code="43">For the prescriber ID submitted, the associated DEA number has been renewed or the renewal is in progress (rarely populated)</value>
                <value code="44">(Unknown value – rarely populated)</value>
                <value code="45">For the prescriber ID submitted, the associated DEA number is a valid hospital DEA number with suffix (rarely populated)</value>
                <value code="Null">Not applicable, beneficiary not in an LTC setting (or in the first two months of 2013, the presumption is there was greater than a 14-day supply)</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="TIER_ID" label="Medicare Part D Formulary Tier Number" length="2" longName="TIER_ID" shortName="TIER_ID" source="PDE and Plan Characteristics (derived)" type="CHAR" valueFormat="Null">
        <comment>
            <p>Part D plan sponsors submit the pricing, tiers, and formularies for their plan benefit packages to CMS via the Health Plan Management System (HPMS).</p>
            <p>This includes information on how many cost-sharing tiers each plan will use and the drugs that will be on each tier. The CCW creates this variable based on the beneficiary’s plan of record, which is identified using the Part D contract and plan benefit package of record (the PLAN_CNTRCT_REC_ID and PLAN_PBP_REC_ID variables). For a small number of beneficiaries, particularly those who changed plans around the time of the fill, the variable may not be an accurate reflection of whether the PDE was on a particular drug tier.</p>
        </comment>
        <description>
            <p>This is a CCW-derived field that indicates the cost-sharing tier in which the prescription was placed, according to the benefit structure and formulary for the beneficiary’s plan.</p>
            <p>If a product is part of two different tiers, this field is populated with the minimum tier value for the product.</p>
            <p>Starting in 2010, this variable is included in the Formulary file (rather than the PDE file).</p>
        </description>
        <valueGroups>
            <valueGroup>
                <description>
                    <p>Null</p>
                </description>
                <value code="1-6">The tier on the plan's formulary associated with the drug on the PDE (Note: if the plan is not required to submit a formulary then TIER_ID is assigned a value of '1')</value>
            </valueGroup>
        </valueGroups>
    </variable>
    <variable id="TOT_RX_CST_AMT" label="Total drug cost (Part D)" length="10" longName="TOT_RX_CST_AMT" shortName="TOTALCST" source="PDE" type="NUM">
        <comment>
            <p>Starting in 2010, this variable includes the vaccine administration fee, when applicable.</p>
        </comment>
        <description>
            <p>This variable is the total cost of the prescription drug event and is taken directly from the original PDE. It is the sum of the following components:  The ingredient cost (INGRDNT_CST_PD_AMT),  The dispensing fee (DSPNSNG_FEE_PD_AMT),  The sales tax, if any (TOT_AMT_ATTR_SLS_TAX_AMT), and  The vaccine administration fee, if any (VCCN_ADMIN_FEE_AMT, included starting in 2010).</p>
            <p>This is the price paid for the drug at the point of sale (i.e., the pharmacy counter), and it does not include any rebates or discounts that the drug manufacturer provides directly to the Part D plan sponsor.</p>
        </description>
    </variable>
</codebook>