CY2011 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

CY 2011 Over the Counter File Record Layout

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

Field Type

NDC

CHAR
Always
Required
CHAR
Always
Required

UM_Type

Step_Therapy_Total_Groups NUM
Sometimes
Required

Maximum
Field
Length
11

1

Field Description

Sample Field Value(s)

11-Digit National Drug Code

00258977120

Indicate whether the NDC will be included as
part of general drug utilization management
program (0) or a formal step therapy protocol
(1). The same NDC cannot be included in both
a general drug utilization management program
and a formal step therapy protocol.

1

2

Enter the total number of step therapy drug
2
treatment groups or protocols in which the drug
is included. If the response to UM_Type = 0
(No), then leave this field blank. The
maximum logical number of groups is "25".
The remaining two fields described below should be repeated as a group or unit in the file.
For example, for a given drug used in multiple Step Therapy programs, the values for Step_Therapy_Group_Desc = “CHF Therapy”
and Step_Therapy_Step_Value = 4 should be included in adjacent columns in the file. Likewise, the values for
Step_Therapy_Group_Desc = “Angina Therapy” and Step_Therapy_Step_Value = 1 should be included in additional adjacent
columns in the file. Likewise, the values for Step_Therapy_Group_Desc = “CVD Therapy” and Step_Therapy_Step_Value = 5 should
be included in additional adjacent columns in the file.

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

CY 2011 Over the Counter File Record Layout

Field Name

Field Type

Step_Therapy_Group_Desc

CHAR
Sometimes
Required

Step_Therapy_Step_Value

NUM
Sometimes
Required

Maximum
Field
Length
100

1

Field Description

Sample Field Value(s)

Description of step therapy drug treatment
groups or protocol. This step therapy group
description must match a description found in
your formulary text file. Field should be
repeated in the record based upon number of
groups declared in
Step_Therapy_Total_Groups. If the response
to UM_Type = 0 (No), then leave this field
blank. Note: For a given NDC each step
therapy group description must be unique.
Identifies the step number or level within the
sequence for the Step Therapy Group. Field
should be repeated in the record based upon the
number of groups declared in
Step_Therapy_Total_Groups AND in the same
order as Step_Therapy_Group_Desc. If the
response to UM_Type = 0 (No), then leave this
field blank. If the response to UM_Type = 1
(Yes), then the only allowable value is 1.

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

Step_Therapy_Step_Value
= 4 (e.g. Step 4 of 6)
Step_Therapy_Step_Value
= 1 (e.g. Step 1 of 3)
Step_Therapy_Step_Value
= 5 (e.g. Step 5 of 5)

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) and semi-colon (;).

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING