CY2021 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

CY 2019 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/RxCUI

CHAR

11

11-Digit National Drug Code (or) RxCUI

00258977120

1

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

0 = general UM
program

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".
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.
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/RxCUI each step therapy group
description must be unique.

2

Always Required
UM_Type

CHAR
Always Required

Step_Therapy_
Total_Groups

Step_Therapy_
Group_Desc

NUM

2

Sometimes
Required

CHAR
Sometimes
Required

100

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1 = formal step
therapy protocol

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

CY 2019 Over the Counter File Record Layout
Field Name

Field Type

Max.Field
Length

Field Description

Sample Field
Value(s)

Step_Therapy_
Step_Value

NUM
Sometimes
Required

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)

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) semi-colon (;).

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