CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

Appendix C - CY 2010 Step Therapy Record Layout

Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”
Field Name

Field Type

Step_Therapy_Group_Desc

CHAR
Always Required

Field
Length
100

Field Description

Sample Field Value(s)

Description of step therapy drug
treatment group. Field should be repeated
in the record based upon number of
groups declared in
Step_Therapy_Total_Groups in the
Formulary File submission upload.

Step_Therapy_Group_Desc =
“CHF Therapy”
Step_Therapy_Group_Desc =
“Angina Therapy”
Step_Therapy_Group_Desc =
“CVD Therapy”

Description of the step therapy group as it
appears on the submitted formulary file.
This field must exactly match the value
entered in the
Step_Therapy_Group_Desc field on the
Formulary File.
Note: For a given Rx CUI, each Group
Description must be unique.

Step_Therapy_Criteria

CHAR
Always Required

4000

Note: For each Step Therapy Group
Description, there must be a Rx CUI with
a Step Therapy Value equal to 1.
Description of the criteria of the step
therapy drug.

Please Note: Certain characters are restricted from HPMS. The submitted file will be rejected if any of the following characters are
included in any field: 1) greater than sign (>), 2) less than sign (<), 3) semi-colon (;), and 4) ampersand (&).