CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

CY 2014 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

Max.Field
Length

Field Description

Sample Field
Value(s)

NDC

CHAR

11

11-Digit National Drug Code

00258977120

1

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.

0

Enter the total number of step therapy drug
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".

2

Always Required
UM_Type

CHAR
Always Required

Step_Therapy_
Total_Groups

NUM

2

Sometimes
Required

1

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.
Step_Therapy_
Group_Desc

Step_Therapy_
Step_Value

CHAR

100

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.

Step_Therapy_
Group_Desc =
"Anti-Histamine
Therapy”;
Step_Therapy_
Group_Desc =
"GERD
Therapy”;

1

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_
Step_Value = 1
(e.g. Step 1 of
3);
Step_Therapy_
Step_Value = 1
(e.g. Step 1 of
2)

Sometimes
Required

NUM
Sometimes
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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