Multiple Drug Categories/Classes
Question:
The schema for the drugs.json doesn’t include the data elements for therapeutic category or class for the drug. Is it possible for a plan to cover a drug differently by category/class or drug indication? Or apply different UM by category/class? For example, if a drug has Prior Authorization for cat/class 1, but doesn’t have the PA for cat/class 2, how should that be represented in the drugs.json file? The same drug ID but with the 2 different coverages?Our drug products include deductibles for certain tiers, followed by copay amounts and, when relevant, coinsurance percentages. how would we report a product with all three?
Answer:
From the JSON file perspective, the lowest level of data collected is RxCUI.Within the cost_sharing section, the array of cost sharing details can be included to detail copay and coinsurance information per drug.
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