This statement identifies the sources from which FillMap Technologies LLC (“FillMap”) derives coverage information, and the known limitations of those sources. It supplements, and does not replace, Section 2 of the Terms of Service. FillMap reproduces what its sources state and does not supply values a source omits.
1. Sources of record
- Medicare Part D — CMS monthly Prescription Drug Plan formulary files; CMS quarterly pricing file. All 50 states, the District of Columbia, and the territories.
- ACA marketplace — the machine-readable plan and formulary files issuers publish under 45 CFR 156.122(d), and the CMS Plan Attributes public use file. 43 states.
- Texas Medicaid — the statewide Vendor Drug Program preferred drug list. Texas only.
- Pharmacy networks — the CMS pharmacy networks file published with the Part D formulary files, which states for each plan the pharmacies in its network and which of them the plan treats as preferred. Medicare only.
- Pharmacy names and addresses — the National Plan and Provider Enumeration System (NPPES). The CMS networks file identifies a pharmacy by number and ZIP code and states no name.
- Distances — ZIP code centroids from the U.S. Census Bureau ZCTA Gazetteer.
- Drug identity — RxNorm (U.S. National Library of Medicine).
Plans offered through an employer or union are not covered by any source above and are absent from FillMap entirely; those plans do not publish drug lists publicly.
2. Marketplaces not represented
Marketplace plans sold in California, Connecticut, the District of Columbia, Maryland, Massachusetts, New Mexico, Rhode Island and Vermont are absent.
The machine-readable files in Section 1 are an artifact of federal marketplace certification, and issuers limit their contents to plans certified for that marketplace. The eight jurisdictions operate their own marketplaces. The effect is observable within a single issuer: Kaiser Permanente sells in California, Maryland and the District of Columbia among others, and its published file contains only its Hawaii and Oregon plans; CareFirst, a Maryland and District of Columbia issuer, publishes a file containing nineteen plans, all of them Virginian. Obtaining these plans requires a data feed from each marketplace operator. FillMap does not derive coverage from issuer formulary documents published for human readers, as doing so would assert tier assignments no source has stated.
3. Issuer files not retrievable
Of 108 marketplace issuer files, 84 are retrieved. The majority of the remainder are dental or vision issuers that publish no drug list; four are served by systems that refuse automated retrieval; the rest are not valid data. Plans belonging to an unretrieved issuer are absent from results. They are never reported as not covered.
4. Plans excluded as not currently offered
Issuer files also contain plans sold outside the marketplace and plans from prior benefit years. FillMap excludes these by reference to the CMS list of plans offered for the current benefit year, including plans whose files described the prior year's coverage. A plan absent for this reason may be an off-marketplace plan.
5. Cost sharing
Where a marketplace issuer's file states a drug tier but omits the associated cost sharing, FillMap reports that no price is published. 517 of 4,415 marketplace plans publish no cost sharing at any tier; a further share publish it for some tiers and not others. Tier assignment is not a monetary amount, and coverage does not imply that a drug is free.
Certain plan marketing names incorporate figures — for example, SimplyOne $3,500 - 30%. Those figures denote the plan's overall deductible and a headline coinsurance rate. They are not the cost sharing applicable to any particular drug tier, and FillMap does not present them as such.
Where an issuer's file omits cost sharing, FillMap uses the cost-sharing data CMS publishes for the same plan and drug tier. It is used only to fill values the issuer left empty; an issuer's own figure is never overwritten. CMS states several amounts per plan, one for each cost-sharing reduction level; FillMap shows the standard amount, which is the one applying to enrollees who do not receive a cost-sharing reduction. If you receive one, you will pay less than the amount shown. This source covers the federal marketplace only; it does not reach the jurisdictions in Section 2.
Two further limits follow from how tiers are named. Where a tier's own published name states that it carries no cost sharing — for example Zero Cost Share Preventive Drugs — FillMap reports $0 for that tier, which is the amount the issuer's own label states and is consistent with the requirement that in-network covered preventive drugs carry no cost sharing. Conversely, where a plan identifies its tiers only by number (Tier 1, Tier 2) and its published cost sharing is recorded against named categories instead, FillMap reports no price rather than infer which number corresponds to which category. That inference is a convention, not a rule, and an incorrect alignment would misstate the amount for every drug on the tier.
For Medicare, the CMS beneficiary cost file states a separate amount for each combination of coverage phase, days supply, and pharmacy type. FillMap shows the 30-day retail amount in the initial coverage phase. Amounts for a 60- or 90-day supply, and for mail order, are published and are not displayed; they are not proportional to the 30-day amount. One plan in this data charges $11 for a 30-day supply of a tier 6 drug and $33 for 90 days, while another charges the same $11 whether the supply is 30 days or 90.
Where a plan operates a preferred pharmacy network, the file states a preferred and a non-preferred retail amount and FillMap shows both, identifying which applies where. 2,151 of 5,496 Medicare plans charge different amounts at the two; the remainder charge one amount at every network pharmacy, and for those plans the choice of pharmacy does not change the price.
Cost-sharing amounts that are published may still differ from the amount you are charged. Amounts vary with deductible status, cost-sharing reductions, pharmacy selection, and days supply, and plans grant exceptions. Your pharmacy can determine the amount applicable to you.
6. Quantity limits
Where a plan limits how much of a drug it will cover at once, FillMap states the limit as the source states it — an amount and a period, such as 60 tablets per 30 days. The amount is counted in the drug's billing unit, which is not always the object dispensed: a limit on a cream is in grams, and one on a pen injector is in millilitres.
Only Medicare publishes the figure. The CMS formulary files carry the amount and the period beside the yes/no. The marketplace machine-readable files carry the flag alone — 1,418 limits with no amount — and the Texas Medicaid list likewise, with 236. For those plans FillMap reports that a limit applies and does not state its size, because no source states it.
Within Medicare the amount is always stated: of 440,947 drug entries carrying a quantity limit, 440,947 state both the amount and the period. Where FillMap shows a limit for a medication without a single figure, it is because the strengths of that medication carry different limits — 30 tablets per 30 days at one strength and 60 at another — and the figure for each strength is listed separately.
A quantity limit is not a refusal. Plans grant exceptions on request, and that request is made by the prescriber rather than by the patient.
7. Pharmacies and networks
Pharmacy network membership is stated per plan by the source in Section 1, and FillMap reproduces it. Three limits apply to how it is presented.
Distances are between ZIP codes, not addresses. The source states a pharmacy's ZIP code and no street coordinates, so a distance is measured from the centre of one ZIP code to the centre of another. Every pharmacy sharing a ZIP code is therefore shown at the same distance, and a pharmacy in the reader's own ZIP code is described as such rather than given a figure, a nought being a claim that it is at their door. The figures are sufficient to determine which pharmacies lie within a radius and insufficient to rank those within one ZIP code against each other.
A pharmacy the source names is not necessarily open, nor stocking a given drug. Network membership is a contractual fact published in advance. FillMap holds no opening hours and no inventory, and states neither.
Dispensing fees are not included. Plans publish a dispensing fee per pharmacy, and FillMap does not display it or add it to any total. Amounts shown are cost sharing only.
A pharmacy whose identifier is absent from the naming source in Section 1 is displayed by identifier. It remains in the plan's network; only its name is unavailable.
8. Help with drug costs
A reader may state that they receive Medicaid, a Medicare Savings Program, or Supplemental Security Income, each of which enrols a person in the Part D low-income subsidy (“Extra Help”) by operation of law. Where that is stated, FillMap applies the statutory maximum copayment for the benefit year in place of the plan's published cost sharing, and applies no deductible, those being the amounts the statute fixes.
The premium subsidy is not modelled. Extra Help also pays some or all of a plan's monthly premium, up to a benchmark that varies by region and by year. FillMap does not hold those benchmarks. Premiums, and any total containing a premium, are shown at the plan's full published amount. A reader receiving Extra Help will pay less than the premium shown, and in many cases nothing.
Enrolment in the subsidy, and the level of it, are determined by the Social Security Administration and by state Medicaid agencies. FillMap does not determine eligibility and a statement made here is not an application.
9. Identifiers shown in place of names
A limited number of plans are displayed under a federal identifier, such as 20507VA1410073, and a limited number of issuers under a web address. These are plans in the jurisdictions identified in Section 2, for which no naming source is available. FillMap displays the identifier rather than attribute a plan or issuer to an entity that no source names.
10. Currency
Medicare formulary files are published monthly and pricing files quarterly; marketplace files are published per benefit year; the Texas Medicaid list follows its own schedule. Each coverage result states its source and the date on which FillMap last retrieved it. A source may be outdated when published, and a plan may change its coverage after publication.
11. Practices
FillMap does not:
- supply a coverage determination, tier, or amount that its sources do not state;
- display cash or discount-card prices on Medicaid results, where cost sharing is at or near zero;
- collect names, dates of birth, member identifiers, or health histories. A plan entered for a lookup is not retained against any person;
- recommend starting, discontinuing, or substituting any medication.
12. Reporting an error
Report suspected errors through the support page, identifying the plan and the medication.