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    • Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information

    Metadata Updated: March 1, 2025

    The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans).

    Notice: CMS has identified an issue that resulted in a 15% coinsurance for plans with Defined Standard benefits to be listed rather than a 25% coinsurance in the Beneficiary Cost File under certain scenarios. This issue affected the 2023 Q4 to 2024 Q3 data. CMS will re-post the corrected data in batches between now and May 2025.

    These non-identifiable files are available on a quarterly basis and are comprised of the following tables:

    Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, and prior authorization.
Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators.
Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).
Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
Insulin Beneficiary Cost File - Plan level cost sharing details for insulin at preferred, non-preferred and mail order network pharmacies.

    These are large files and can take time to download. 

    Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.

    The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information is also available to access for the monthly level information.

    Please note:  The Part D benefit year information for plans become available in October of the year prior. For example, year 2024 data is available in the fourth quarter file of 2023. Year 2024 data continues to be available in the Q1-Q3 2024  files, then in the fourth quarter of 2024 year 2025 data becomes available. 

    Estimated release dates for upcoming 2025 quarterly data (files reflect data for the quarter that ended the month before the file was released):

    4/23/25
7/30/25

    Files older than contract year 2019 can be purchased.

    Access & Use Information

    Public: This dataset is intended for public access and use. License: See this page for license information.

    Downloads & Resources

    References

    https://data.cms.gov/sites/default/files/2025-01/7bd09a6f-5384-4f37-9b1b-04ada3b94786/Methodology-SPUF-2025.pdf

    Dates

    Metadata Created Date January 19, 2024
    Metadata Updated Date March 1, 2025
    Data Update Frequency R/P3M

    Metadata Source

    Harvested from Healthdata.gov

    Other Data Resources

    Additional Metadata

    Resource Type Dataset
    Metadata Created Date January 19, 2024
    Metadata Updated Date March 1, 2025
    Publisher Centers for Medicare & Medicaid Services
    Maintainer
    Identifier https://data.cms.gov/data-api/v1/dataset/a94b1015-1b93-476b-80ec-508b4169c8f5/data-viewer
    Data First Published 2023-12-15
    Language en-US
    Data Last Modified 2025-02-27
    Category Medicare
    Public Access Level public
    Data Update Frequency R/P3M
    Bureau Code 009:38
    Metadata Context https://project-open-data.cio.gov/v1.1/schema/catalog.jsonld
    Metadata Catalog ID https://healthdata.gov/data.json
    Schema Version https://project-open-data.cio.gov/v1.1/schema
    Catalog Describedby https://project-open-data.cio.gov/v1.1/schema/catalog.json
    Data Quality True
    Data Dictionary https://data.cms.gov/sites/default/files/2025-01/c299f432-d285-4ed9-9d06-0da14a389ef7/SPUFRecordLayout-2025.pdf
    Data Dictionary Type application/pdf
    Harvest Object Id 1b327692-67c9-4446-95c2-2de4efc11417
    Harvest Source Id 651e43b2-321c-4e4c-b86a-835cfc342cb0
    Harvest Source Title Healthdata.gov
    Homepage URL https://data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers/quarterly-prescription-drug-plan-formulary-pharmacy-network-and-pricing-information
    License https://www.usa.gov/government-works
    Program Code 009:000
    Related Documents https://data.cms.gov/sites/default/files/2025-01/7bd09a6f-5384-4f37-9b1b-04ada3b94786/Methodology-SPUF-2025.pdf
    Source Datajson Identifier True
    Source Hash b7fed9a05f2b379134223f42351b5128926e2ced712d80af97075fb233724cf0
    Source Schema Version 1.1
    Temporal 2019-01-01/2024-12-31

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