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

CY 2011 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
ST_Criteria_Change_Indicator

CHAR
Always Required
CHAR
Always Required

4000
1

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.
If the ST criteria content did not change for this
group description compared to CY 2010, please
place a “0” in this field. If this group
description is new, or the criteria content
changed in any way, please place a “1” in this
field”.

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 (&).

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING