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Pharmacy Benefits Verification Data Model
Pharmacy Benefits Verification uses a data model that’s FHIR-CARIN and NCPDP aligned to store the data and make the data model interoperable.
Required Editions
| Available in: Lightning Experience |
| Available in: Enterprise and Unlimited Editions with Life Sciences Cloud or Health Cloud |
Here’s the set of objects pharmacy benefits verification requests and responses use, and the level of access that your users need for those objects.
Note The table covers base objects first, followed by objects specific to this feature.
| Object | Purpose | Access |
|---|---|---|
| Account | Business Accounts represent organizations involved with your business and Person Accounts represent patients. |
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| Contact | Represents a contact, which is a person associated with an account. |
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| Contact Point Address | Represents a contact’s billing or shipping address, which is associated with an individual or person account. |
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| Contact Point Phone | Represents a contact’s phone number, which is associated with an individual or person account. |
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| Member Plan | Represents the details of the insurance coverage for a member or subscriber. |
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| Purchaser Plan | Represents the payer plan that a purchaser makes available to its members and members’ dependents. |
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| Medication | Represents detailed information of different medications. |
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| Medication Request | Represents a request or order for the supply of a medication. |
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| Healthcare Provider | Represents business-level details of the healthcare organization or the prescriber. |
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| Healthcare Provider NPI | Represents identifiers from the National Provider Identifier that are assigned to every facility and licensed practitioner in the United States. |
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| Identifier | Represents the identifier information for a healthcare provider. |
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| Code Set | Represents various life sciences defined codes in the context of their systems and versions of those systems. These codes are used in all sorts of digital records. |
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| Unit of Measure | Represents the units of measure for products and care program products. |
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| Care Program | Represents a set of activities, such as a patient therapy, financial assistance, education, wellness, or fitness plan, offered to participants by an employer or insurer. |
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| Care Program Enrollee | Represents a patient enrolled in a care program. |
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| Care Program Product | Represents the affiliation between a care program and a care program product, care program provider, or both. |
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| Product | Represents a drug or a medication that’s prescribed to a care program enrollee. |
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| Care Benefit Verify Request | Represents a request for the verification of pharmacy benefits. |
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| Coverage Benefit | Represents the pharmacy benefits provided to a patient covered by a purchaser’s plan. |
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| Coverage Benefit Item | Represents a specific service covered by the insurance plan. |
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| Coverage Benefit Item Limit | Represents the details associated with a specific benefit as it relates to expenditures, limits, coverage levels, eligibility, and exclusion. |
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