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

CY 2015 Step Therapy File Record Layout
Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”
During the initial formulary submission period the file must include all Step Therapy Group
Descriptions. All records must have ADD for the Change_Type.
After the initial formulary submission period the file must include only changes.
Field Name

Field Type

Maximum
Field
Length

ST_Change_Type

CHAR

3

Always Required

Step_Therapy_Grou
p_Desc

CHAR

100

Always Required

Field Description

Defines the type of change that is
being made to the Step Therapy
File.

ADD = Add
Group
Description to
file

During the initial formulary
submission period, all rows must
be “ADD.”

UPD = Change
fields for an
existing Group
Description

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”

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
Always Required

4000

Sample
Field Value(s)

Description of the criteria of the
step therapy drug.

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Step_Therapy_
Group_Desc =
“Angina
Therapy”

CY 2015 Step Therapy File Record Layout
ST_Criteria_Change
_Indicator

CHAR
Always Required

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”.

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 (;).

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