Drug Plan General Costs

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_plan_general_costs`	`plan:drug-plan.generalCost` of the Payer Insurance Plan	0..*

A general cost is a cost of the drug plan that is not tied to a drug tier: the premium, a deductible, an out-of-pocket maximum. The profile leaves it optional and unconstrained; it is here because the IG's plan-shopping use case is about comparing exactly these.

drug_plan_general_costs

One row per general cost of a drug plan.

Column	Required	Format / values	Example
`drug_plan_id`	Yes	key from `drug_plans`	`DP-DSNP`
`cost_type`	Yes	your code for the kind of cost, with `cost_type_system`; the profile binds nothing here	`premium`
`cost_type_system`	If coded	code system URI of `cost_type`; blank publishes it as text
`group_size`	If available	integer; number of enrollees the cost applies to, for family or group premiums	`1`
`amount`	Yes	decimal, US dollars	`0.00`
`comment`	If available	free text shown with the amount	`No monthly premium for members with full Medicaid`
`is_deleted`	If retracting	`true` retracts this row	`true`

A row is identified by drug_plan_id, cost_type and group_size together.
cost_type has no value set in the profile. Use one vocabulary consistently, such as premium, deductible, out-of-pocket-maximum, and tell us at scoping so it is registered as a code system; otherwise it is published as text.

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