Formularies

Datasets

Part of the Drug Formulary feed, built to Da Vinci PDex US Drug Formulary STU 2.1.0. The feed's data conventions apply.

Dataset	US Drug Formulary STU 2.1.0 target profile
`formularies`	Formulary (InsurancePlan)

One row per formulary. A formulary is a plan-year list; a new plan year is a new row with a new formulary_id.

Column	Required	Format / values	Example
`formulary_id`	Yes	your stable key; `payer_plans` and `formulary_items` reference it	`FORM-2027-A`
`cms_formulary_id`	If Part D	the 8-digit CMS formulary id from your HPMS submission	`00027113`
`formulary_name`	Recommended	text	`Example Health 2027 Part D Formulary`
`formulary_aliases`	If renamed	earlier names, `;`-separated, so old searches still find it
`status`	Yes	`active`, `draft`, `retired`, `unknown` publication-status	`active`
`period_start`	Recommended	date the formulary takes effect	`2027-01-01`
`period_end`	Recommended	date the formulary expires	`2027-12-31`
`owned_by_org_npi`	Recommended	10 digits; the plan sponsor that issues the formulary; key from `organizations`	`9999999993`
`administered_by_org_npi`	If different	10 digits; the PBM or administrator that maintains it; key from `organizations`	`9999999994`
`network_ids`	If available	pharmacy networks the formulary applies to, keys from Provider Directory `networks`, `;`-separated	`NET-001`
`coverage_area_states`	If available	2-letter USPS states, `;`-separated; `US` for nationwide	`NY`
`formulary_url`	Recommended	printable formulary page for this list	`https://example.org/formularies/2027-a.pdf`
`last_updated`	Yes	datetime the formulary last changed in your system	`2026-10-01T09:00:00-05:00`
`is_deleted`	If retracting	`true` retracts this row	`true`

The profile requires at least one identifier. formulary_id becomes it, under the identifier namespace fixed for your engagement, so you do not send a system. cms_formulary_id becomes a second identifier for the CMS-assigned id, under the CMS formulary-id system fixed at scoping, since CMS publishes no URI for it.
A formulary needs a name or an id; both are better. Payerbox sets its type to drug policy and its plan type to drug, which is what marks an InsurancePlan as a formulary rather than a payer plan.
owned_by_org_npi, administered_by_org_npi and network_ids are the same keys the Provider Directory plans dataset uses, so a formulary and the plan that uses it name the same sponsor and networks. coverage_area_states follows the payer_plans rule: one Location per state, generated by Payerbox.
formulary_url becomes the formulary contact. The IG expects the printed formulary to be reachable from the resource for rules the structured columns cannot carry.

These resources are served by Patient Access.