MA pbp section b15 partb rx drugs

What it is

1. 1CMS Plan Benefit Package (PBP) Section B-15: the Medicare Advantage / MA-PD plan benefit design for PART B Rx DRUGS (physician-administered drugs covered under Part B — chemotherapy, home-infusion, IRA-capped insulin, etc.), i.e. the cost-share RULES (prior-auth, coinsurance %, copays, deductible, step therapy, max-OOP) each plan files with CMS each year.
2. 2It is plan-design cost data (what the plan WILL charge), not claims or paid amounts.
3. 3Sourced from the CMS PBP Public Use Files, 2008-2026.

Grain

How to read it

1. 1Latest-snapshot Part B drug cost-share for current MA plans: SELECT contract_id, plan_id, mrx_b_auth_yn, mrx_b_coins_yn, mrx_b_step_tpy_yn, mrx_b_hi_yn, mrx_b_ira_coins_yn FROM medicare_silver.pbp_section_b15_partb_rx_drugs WHERE report_year=2026 AND quarter=1.
2. 2Answers 'for each 2026 MA/MA-PD plan, does the Part B drug benefit require prior authorization / step therapy / coinsurance, and does it cover home-infusion and IRA-capped drugs?' To trend coinsurance %, restrict to report_year<=2017 (where mrx_b_coins_pct is populated) and always pick MAX(quarter) per plan-year to avoid snapshot double-counting.

Traps

1. 1DEAD COLUMNS: all 149 pbp_b15_* columns (grp1-5 tiers, coins/copay/ded/maxplan/bendesc/maxenr) are 100% NULL/empty across every one of the 189,385 rows — they are schema placeholders from a newer PBP layout that was never populated here. The only columns carrying data are the 53 mrx_b_* fields plus the id/plan-context/provenance columns. Do NOT build any analysis on a pbp_b15_* column.
2. 2SNAPSHOT DOUBLE-COUNTING: there is NO is_current column. A plan can appear up to 4 times in one report_year (once per quarterly CMS re-release: quarter 1-4, 1:1 with cms_vintage_sequence). Years 2018,2019,2020,2022,2023,2024 are multi-snapshot; the rest are single (quarter=1). Counting plans, averaging cost-share, or joining without first picking MAX(quarter)/MAX(cms_vintage_sequence) per (contract,plan,segment,report_year) inflates results ~1.85x overall.
3. 3SCHEMA-ERA SHIFT in populated fields: the detailed legacy cost-share numbers (mrx_b_coins_pct, mrx_b_chemo_*, min/max pct & dispensing fees) are populated ONLY 2008-2017 and go NULL from 2018 on. Conversely the IRA fields (mrx_b_ira_*) appear ONLY 2024+. mrx_b_auth_yn (prior-auth) is the one field present the whole 2008-2026 span. Trend queries on coinsurance % will silently break at 2018.
4. 4YN CONVENTION IS 1/2, NOT 1/0: every *_yn flag uses CMS coding '1'=Yes, '2'=No (stored as strings). Treating '2' as falsy-zero or summing them is wrong. Likewise coins_covbasis (1-10), coins_ehc (01/10/11), orgtype, and pbp_a_plan_type are CMS LOOKUP CODES needing the PBP data dictionary, not literal values.
5. 5NULL MOSTLY MEANS 'NOT APPLICABLE / NOT THIS MECHANISM', not zero: mrx_b_ded_amt is non-null on just 7 rows (all $131) and mrx_b_max_oop_amt on ~773 — a NULL deductible/OOP does not imply $0. mrx_b_coins_pct is NULL where the plan uses copay instead of coinsurance.
6. 6IDENTITY TRAPS: bid_id looks like a primary key but is a redundant concatenation of the three id columns; version looks temporal but is the per-bid revision number (scalar per row, not a snapshot). asserted_at has only 2 values (2026-05-16/20) — this is a one-time historical backfill, not a live feed, so 'latest asserted_at' is meaningless for currency; use report_year + quarter/vintage instead.

Columns (232)

Query it

describe_data_source(source_fqn="medicare_silver.pbp_section_b15_partb_rx_drugs")     # the card, live
query_substrate(sql="SELECT * FROM medicare_silver.pbp_section_b15_partb_rx_drugs WHERE contract_id = '<value>' AND plan_id = '<value>' AND segment_id = '<value>' AND report_year = '<value>' AND quarter = '<value>' LIMIT 100")