Monthly Prescription Drug Plan Formulary and Pharmacy Network Information

CMS's description

The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information files contain formulary and pharmacy network 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 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, prior authorization, and a newly added Selected Drug flag.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, and brand, generic, and selected drug dispensing fees for 30/60/90 days supply, respectively.Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.Insulin Beneficiary Cost File - Plan level copay and coinsurance amounts for insulin at preferred, non-preferred and mail order network pharmacies. These are large files and can take time to download. Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity. The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information is also available to access for the quarterly level information. Please note: The Part D benefit year information for plans become available in October of the year prior. For example, year 2026 data is available in the October, November and December 2025 monthly files. Year 2026 data continues to be available in the January through September 2026 monthly files, then beginning in October of 2026 year 2027 data becomes available.Estimated release dates for upcoming monthly data (files reflect data for the month in which the file is released):11/25/2612/23/261/20/272/17/273/17/274/28/275/26/276/23/277/21/278/18/279/29/27Files older than contract year 2019 can be purchased.

Methodology and other documents from CMS:

• Methodology PUF 2027 (PDF)

The summary at the top is the first sentence of this description. Record id cms:cb2a224f-4d52-4cae-aa55-8c00c671384f. This record as JSON.