User Tools

Site Tools



This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revision Previous revision
documentation:cdm:drug_cost [2016/05/03 19:58]
documentation:cdm:drug_cost [2016/05/03 19:58] (current)
Line 4: Line 4:
 For prior definition, see below. For prior definition, see below.
 ---- ----
 +The DRUG_COST table captures records containing the cost of a Drug Exposure. The information about the cost is defined by the amount of money paid by the Person and Payer for the Drug, as well as the charged cost of the Drug. In addition, a reference to the health plan information in the PAYER_PLAN_PERIOD table is stored in the record that is responsible for the determination of the cost as well as some of the Payments.
 +|drug_cost_id|Yes|integer|A unique identifier for each DRUG_COST record.|
 +|drug_exposure_id|Yes|integer|A foreign key identifier to the Drug record for which cost data are recorded.|
 +|currency_concept_id|No|integer|A concept representing the 3-letter code used to delineate international currencies, such as USD for US Dollar.|
 +|paid_copay|No|float|The amount paid by the Person as a fixed contribution to the expenses. Copay does not contribute to the out of pocket expenses.|
 +|paid_coinsurance|No|float|The amount paid by the Person as a joint assumption of risk. Typically, this is a percentage of the expenses defined by the Payer Plan after the Person'​s deductible is exceeded.|
 +|paid_toward_deductible|No|float|The amount paid by the Person that is counted toward the deductible defined by the Payer Plan.|
 +|paid_by_payer|No|float|The amount paid by the Payer. If there is more than one Payer, several DRUG_COST records indicate that fact.|
 +|paid_by_coordination_benefits|No|float|The amount paid by a secondary Payer through the coordination of benefits.|
 +|total_out_of_pocket|No|float|The total amount paid by the Person as a share of the expenses.|
 +|total_paid|No|float|The total amount paid for the expenses of drug exposure.|
 +|ingredient_cost|No|float|The portion of the drug expenses due to the cost charged by the manufacturer for the drug, typically a percentage of the Average Wholesale Price.|
 +|dispensing_fee|No|float|The portion of the drug expenses due to the dispensing fee charged by the pharmacy, typically a fixed amount.|
 +|average_wholesale_price|No|float|List price of a Drug set by the manufacturer.|
 +|payer_plan_period_id|No|integer|A foreign key to the PAYER_PLAN_PERIOD table, where the details of the Payer, Plan and Family are stored.|
 +==== Conventions ====
 +  * Each Drug Exposure may have any number of corresponding records in the DRUG_COST table, but usually it is none (no cost data recorded) or one. They are linked directly through the drug_exposure_id field.
 +  * The amounts paid are:
 +    * Copay – a fixed amount to be paid by the Person
 +    * Coinsurance – a relative amount of the total paid by the Person
 +    * Deductible – an amount of money paid by the Person before the Payer starts contributing
 +    * Primary Payer – the amount the primary Payer pays towards the total
 +    * Coordination of Benefits – the amount a secondary Payer or Family Plan pays towards the total
 +    * Out of Pocket = Copay + Coinsurance + Deductible
 +    * Total – the total amount paid for the Drug Exposure
 +  * Drug costs are:
 +    * Ingredient Cost – the amount charged by the wholesale distributor or manufacturer
 +    * Dispensing Fee – the amount charged by the pharmacy
 +    * Sales Tax. This is usually very small and typically not provided by most source data, and therefore not included in the CDM
 +  * The amount paid should equal the cost, so Copay + Coinsurance + Deductible + Primary Payer + Coordination of Benefits = Total Paid = Ingredient Cost + Dispensing Fee. In reality, this is not always reflected in the source data. It is up to the ETL to determine how to deal with quality problems in the data.
 +  * The Average Wholesale Price is the list price of the drug, but not the price actually charged or paid.
documentation/cdm/drug_cost.txt · Last modified: 2016/05/03 19:58 by cgreich