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).
Medicare Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information
Description
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.
- 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)
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 – and in the files themselves. The record layout and data dictionary for the formulary file are subject to change.
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.
Source links
Download
- Data Format: CSV text file
- Approximate Size: 2.5 GB
- Total database space about 40 GB
Update frequency
The new Part D benefit year information for plans are available in the October, November and December monthly files, and 4th quarterly file. (i.e., year 2022 data is available in the October 2021 monthly file and the 4th quarter 2021 file). Part D benefits and formulary are included in monthly and quarterly files; estimated drug pricing data is only available in quarterly files.
Projected release dates for 2022 monthly data: 01/10/22, 02/21/22, 03/21/22, 04/18/22, 05/16/22, 06/13/22, 07/11/22, 08/08/22.
Projected release dates for 2022 quarterly data: 01/10/22, 04/11/22, 07/05/22 (files reflect data for the previous quarter).
Licensing
Terms and conditions
Table info
See PDF "Record-Layout" files at bottom of page for more detailed info.
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2022 Monthly Files
NOTE: Pricing files are NOT available in monthly data.
2022 Quarterly Files
NOTE: Pricing files are only available in quarterly data.
