Drug Plans

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_plans`	`plan:drug-plan` of the Payer Insurance Plan	1..*

A drug plan is the cost-sharing structure offered under a payer plan. A product usually has one; a product sold with several cost-sharing designs has one per design. Its cost table lives in the three datasets below it.

drug_plans

One row per drug plan.

Column	Required	Format / values	Example
`drug_plan_id`	Yes	your stable key for the drug plan; it becomes the drug plan's identifier and links a member's Coverage to it	`DP-DSNP`
`plan_id`	Yes	key from `payer_plans`	`PLAN-DSNP`
`identifier_values`	If available	further identifiers of the drug plan, `;`-separated, aligned with `identifier_systems`	`H6776-001-000`
`identifier_systems`	If `identifier_values`	namespace URI of each, aligned	`http://cms.gov/medicare/ma-plan-id`
`coverage_area_ids`	If different from the plan's	keys from `coverage_areas`, `;`-separated
`network_ids`	If available	pharmacy networks of this drug plan, keys from Provider Directory `networks`, `;`-separated	`NET-001`
`is_deleted`	If retracting	`true` retracts the drug plan and its cost table	`true`

drug_plan_id is published as the drug plan's identifier, which 2.1.0 made must-support so a member's Coverage can point at the drug plan inside a product. Keep it stable; enrollment data will reference it.
type is fixed to drug and set by Payerbox.
identifier_values and identifier_systems are one aligned list. They become further identifier entries after drug_plan_id; the profile marks the drug plan identifier must-support and repeatable.
Not collected: plan.generalCost is its own dataset, drug_plan_general_costs; nothing else of the drug plan is left out.
A drug plan needs at least one specific cost; a drug_plans row with none is reported and not published.

These resources are served by Patient Access.