Drug Coverages

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
`plan_drug_coverages`	`coverage:drug-coverage` of the Payer Insurance Plan	1..*

A drug coverage is the statement that the plan covers drugs and which formulary lists them. Most plans have exactly one; a plan whose Part D benefit is split across formularies for different groups has one per formulary set.

plan_drug_coverages

One row per drug coverage of a plan.

Column	Required	Format / values	Example
`coverage_id`	Yes	your stable key for the coverage; `drug_coverage_benefits` references it	`COV-DSNP-RX`
`plan_id`	Yes	key from `payer_plans`	`PLAN-DSNP`
`formulary_ids`	Yes	keys from `formularies`, `;`-separated; one in the usual case	`FORM-2027-A`
`network_ids`	If available	pharmacy networks providing this coverage, keys from Provider Directory `networks`, `;`-separated	`NET-001`
`is_deleted`	If retracting	`true` retracts this row and its benefits	`true`

formulary_ids fills the formulary-reference extension the profile requires on every drug coverage; the profile allows several, which is why it is a list. Each must exist in formularies.
The coverage's type is fixed to drug policy and set by Payerbox.
Every coverage needs at least one benefit. Where you send none, Payerbox adds the one bare drug benefit the profile demands.

These resources are served by Patient Access.