Drug Coverage Benefits

Datasets

Part of the Payer Plans group 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 element	Cardinality
`drug_coverage_benefits`	`coverage:drug-coverage.benefit:drug-plan` of the Payer Insurance Plan	1..*

The benefit is the profile's statement that the coverage is a drug benefit. Its type is fixed; what you may add is a requirement and limits, the only data the element carries.

drug_coverage_benefits

One row per benefit of a drug coverage. Send a row only when you have a requirement or a limit to state; otherwise Payerbox adds the mandatory benefit itself.

Column	Required	Format / values	Example
`benefit_id`	Yes	your stable key for the benefit	`BEN-DSNP-RX`
`coverage_id`	Yes	key from `plan_drug_coverages`	`COV-DSNP-RX`
`requirement`	If available	free text; referral or other requirement for the benefit	`Part D covered drugs only`
`limit_values`	If a limit	decimals, `;`-separated, aligned with `limit_units` and `limit_codes`	`90`
`limit_units`	If a limit	unit of each limit value, aligned	`days`
`limit_codes`	If a limit	what each limit is, aligned; your own code or label	`days-supply`
`is_deleted`	If retracting	`true` retracts this row	`true`

type is fixed to drug and set by Payerbox.
The three limit columns are one aligned list: position one of each describes the first limit. A limit needs at least a value.

These resources are served by Patient Access.