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

CY 2012 Step Therapy File Record Layout
Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”
Field Name

Step_Therapy_Grou
p_Desc

Field Type

CHAR

Maximum
Field
Length
100

Always Required

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”

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.

Step_Therapy_
Group_Desc =
“CVD Therapy”

Step_Therapy_
Group_Desc =
“Angina
Therapy”

Note: For a given Rx CUI, each
Group Description must be unique.
Note: For each Step Therapy
Group Description, there must be a
Rx CUI with a Step Therapy Value
equal to 1.
Step_Therapy_Criter
ia

CHAR

ST_Criteria_Change
_Indicator

CHAR

4000

Description of the criteria of the
step therapy drug.

1

If the ST criteria content did not
change for this group description
compared to CY 2011, 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”.

Always Required

Always Required

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 (<), and 3) semicolon (;).

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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