Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Primary tabs

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.

Other Access

The information on this page (the dataset metadata) is also available in these formats.

JSON RDF

via the DKAN API

#DDOD Use Case: Access to Medicare Part D Drug Event File (PDE) for cost transparency

SUMMARY

DDOD use case to request access to Medicare Part D Drug Event File (PDE) for cost transparency to pharmacies and patients.

WHAT IS A USE CASE?

A “Use Case” is a request that was made by the user community because there were no available datasets that met their particular needs. If this use case is similar to your needs, we ask that you add your own requirements to the specifications section.

The concept of a use case falls within the Demand-Driven Open Data (DDOD) program and gives you a formalized way to identify what data you need. It’s for anyone in industry, research, media, nonprofits or other government agencies. Each request becomes a DDOD use case, so that it can be prioritized and worked on.

Use Cases also provide a wealth of insights about existing alternative datasets and tips for interpreting and manipulating data for specific purposes.

PURPOSE

The PDE data contain prescription drug costs and payment data that enable CMS to make payments to the plans and otherwise administer the Part D benefit. When a beneficiary fills a prescription under Medicare Part D, a prescription drug plan sponsor must submit a record to CMS. The PDE data are not the same as individual drug claim transactions but are extracts using CMS-defined standard fields. The challenge is that this data is not available publicly, even with all PHI fields stripped out. It resides in ResDAC/CCW, but has 1 year lag time and 3-4 months processing time.

VALUE

Central to operations for drug cost comparisons for use by pharmacists and consumers. Multiple companies are looking how to better manage costs.

USE CASE SPECIFICATIONS & SOLUTION

Information about this use cases is maintained in a wiki: http://hhs.ddod.us/wiki/Use_Case_26:_Analyze_drug_cost_trends_from_fille...

It serves as a knowledge base.

USE CASE DISCUSSION FORUM

All communications between Data Users, DDOD Administrators and Data Owners are logged as discussions within GitHub issues: https://github.com/demand-driven-open-data/ddod-intake/issues/26

It aims to provide complete transparency into the process and ensure the same message gets to all participants.

CASE STATUS

Open

FieldValue
Publisher
Modified
2020-03-04
Release Date
2015-05-07
Identifier
92608043-d959-4ae3-be85-6b93b0c858e3
License
Author
Centers for Medicare & Medicaid Services
Data Dictionary
Contact Name
David Portnoy
Contact Email
Additional Info: 
FieldValue

Agency Program URL

http://www.resdac.org/cms-data/files/pde

Collection Instrument

https://github.com/demand-driven-open-data/ddod-intake/issues/26

Date Released

2015-04-29 00:00:00

Group Name

#DDOD Use Case

Subject Area 1

Health Care Cost

Subject Area 2

Medicare

Technical Documentation

https://github.com/demand-driven-open-data/ddod-intake/wiki/Use-Case-26

Unit of Analysis

drug label

author_id

http://healthdata.gov/id/agency/cms

hd2-workflow-id

68595

publisher_1

Department of Health & Human Services

Bureau Code
009:38 - Centers for Medicare and Medicaid Services
Program Code
009:078 - Department of Health and Human Services - Medicare
Data Quality
False