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Technical Details

Dataset Description
The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information files contain formulary and pharmacy network 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 October 2023 to November 2024 data. CMS has re-posted the corrected data as of May 2025.   These non-identifiable files are available on a monthly 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. 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 Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information is also available to access for the quarterly 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 October, November and December 2023 monthly files. Year 2024 data continues to be available in the January through September 2024 monthly files, then beginning in October of 2024 year 2025 data becomes available. Estimated release dates for upcoming 2025 monthly data (files reflect data for the month in which the file is released): 6/18/25 7/30/25 8/27/25 9/24/25 Files older than contract year 2019 can be purchased.
MetaData
Landing Page

https://data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers/monthly-prescription-drug-plan-formulary-and-pharmacy-network-information

Keywords

Medicare, Medicare Advantage, Medicare Prescription Drug, All Other Provider Care Types, Drugs, Health Care Use & Payments

Publisher

Centers for Medicare & Medicaid Services

Program Code

09:00

Bureau Code

09:38

Monthly Prescription Drug Plan Formulary and Pharmacy Network Information

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Getting CMS data into your dashboards shouldn’t require a team of engineers. We automate the end-to-end process, from pulling fresh datasets from data.cms.gov, to cleaning, structuring, and feeding them into your BI environment.

 

Whether you’re using Power BI, Tableau, Metabase, or need help picking the right tool, we make sure your data is accurate, up-to-date, and always ready for analysis.

Our Expertise With Health Care Data Integration

Anyone can wire up a CMS API. Red Corner has done far more than we’ve led data platform projects in providers, payers, and analytics firms, where CMS data wasn’t optional; it was mission-critical. We understand the downstream pressure: reports must run, queries must work, and decision-makers need answers quickly.

 

That’s why we build systems that aren’t just technically correct; they’re reliable under pressure, scalable, and deeply aligned with your business goals.

The Red Corner Approach

Most teams stop at pulling CMS data. We don’t. Red Corner understand that raw CMS datasets are messy, often duplicated, inconsistently structured, and a pain to work with.

 

That’s why we build more than just pipelines. We design and maintain robust processing systems that normalize, clean, and reshape CMS data into models that analysts and BI tools can work with immediately.

 

We don’t just deliver data; we deliver clarity, speed, and answers.

Foundational

We’ve already done the heavy lifting. Red Corner builds and manages robust systems that extract, clean, and structure CMS data reliably, so you don’t have to sink hundreds of thousands of dollars into solving the same problems.

 

From day one, your team gets access to a dependable, production-grade pipeline that’s been hardened across multiple clients and use cases. It’s plug-in ready, maintainable, and built for scale.

1

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Evolution

Once your CMS data is flowing and structured, we don’t stop. Red Corner ensures historical consistency by storing and managing all past data in the same unified structure. That means the reports you build today won’t break tomorrow, even as CMS releases new versions or modifies schemas.

 

We will also guide you through understanding where this stability delivers cost savings, analytics acceleration, and long-term ROI across teams.

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Growth

With a reliable CMS data pipeline in place, your organization can stop relying on analysts for every insight.

 

Red Corner structures your data to work natively with modern BI tools, enabling business leaders to explore trends, spot risks, and make informed decisions without bottlenecks.

 

We will help extend that reach across teams, empowering everyone to move faster with data they can trust.

Expert Guidance

We have worked deep in the healthcare trenches, where CMS data is not just a compliance tool but a driver of strategic decisions. We’ve seen the pitfalls: broken queries, outdated datasets, overworked analysts, and built systems that avoid them.

 

With Red Corner, you’re not just getting someone to wire up a feed. You’re getting a seasoned partner who knows how CMS data powers quality improvement, benchmarking, and real-world business outcomes.

Continuous Support

The moment you sign up with us, your CMS data stays fresh. Red Corner ensures automated, ongoing updates from data.cms.gov starting on day zero. No stale reports, no surprise schema changes.

 

We monitor, manage, and maintain the entire flow so your teams always have access to the latest available data, ready for analysis when you need it.

Tailored Solutions

Whether you need your CMS data in your existing Power BI, Tableau, or Metabase setup or you’re starting from scratch, we’ve got you covered.

 

Red Corner offers a ready-to-use, self-service BI interface that lets your team chat with the data directly, no SQL or tech support required. Prefer your own environment? We’ll integrate clean, query-ready data right into your existing tools. 

Innovative Approach

Innovation, for us, means cutting through the usual complexity. With Red Corner, your CMS data arrives report-ready from day one, clean, structured, and instantly usable in any BI tool. No manual wrangling, no delayed timelines, no guesswork.

 

We’ve built a system that turns a messy public dataset into a plug-and-play source of truth, so your team can skip straight to insights.

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FAQ

  1. What CMS datasets can you integrate?

    We support a wide range of datasets published on data.cms.gov, including Medicare Provider Utilization, Hospital Quality, Medicare Advantage plan ratings, and more. If it’s available from CMS, we can pull it, process it, and deliver it into your analytics workflow fully structured and analysis-ready.
     

  2. How often is the data updated?

    We update CMS data weekly, as new files are published. Our system automatically detects updates, processes the latest versions, and syncs them to your destination, whether that’s a BI tool, a data warehouse, or our self-service interface. You don’t have to lift a finger.
     

  3. Do you clean and structure the CMS data?

    Yes. CMS datasets are often unstructured, inconsistent, and full of duplicate entries. We clean every record, normalize date formats, and ensure column consistency so that your analysts spend time analyzing, not fixing broken rows and cells.
     

  4. Can you integrate with our existing BI tools?

    Absolutely. Whether you use Power BI, Tableau, Metabase, Looker, or another tool, we adapt to your environment. If you don’t yet have a BI tool, we’ll provide a powerful self-service interface where your team can explore and visualize the data from day one.
     

  5. How do you handle schema changes from CMS?

    CMS can change field names, column formats, or file layouts without notice. Our pipelines track version changes, test against historical schemas, and preserve your existing data model. That means your reports don’t break, even when CMS makes changes upstream.
     

  6. Is this secure and compliant with healthcare standards?

    Yes. However, due to the public nature of the data, HIPAA does not apply.
     

  7. Do I need a technical team to manage this?

    No. Red Corner manages the full stack from ingestion to transformation to delivery. Your team gets clean, up-to-date data in the tools they already use, without needing internal engineers to maintain scripts or fix broken pipelines.
     

  8. What if I need historical data?

    We don’t just keep current data; we preserve all historical files in the same structured schema. This makes it easy to build reports over time, compare year-over-year trends, and answer complex analytical questions without having to jump through hoops.
     

  9. Can you help with analytics and reporting?

    Yes. We provide not only the data but also expert analysts who understand the healthcare context behind it. Whether you need ad hoc reports, dashboard design, or help interpreting trends, we’re here to support your goals, not just deliver files.
     

  10. What’s the onboarding time?

    In most cases, we can have your CMS data live and integrated in under a few weeks. Our systems are built and battle-tested, which means we don’t start from scratch; we start with what works and tailor it to your needs.

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