Pharmacy Claims Data Elements
| Data Element | Description | Analytics Use |
|---|---|---|
| NDC (National Drug Code) | 11-digit code identifying the specific drug product | Drug identification; formulary analysis |
| Drug name and strength | Generic and brand name; dosage strength | Drug categorization; formulary analysis |
| Quantity and days supply | Amount dispensed; days of therapy | Adherence analysis; quantity limit compliance |
| Prescriber NPI | Prescriber identifier | Prescriber pattern analysis |
| Pharmacy NPI | Dispensing pharmacy identifier | Network compliance; mail order analysis |
| Plan cost and member cost | Amount paid by plan and member | Cost analysis; cost-sharing analysis |
Data Quality
Pharmacy claims data quality is essential for accurate analytics. Common data quality issues: (1) missing NDC codes; (2) incorrect days supply; (3) missing prescriber information; and (4) duplicate claims. Request a data quality report from your PBM and address any quality issues before conducting analytics.
Data Privacy
Compliance Note
Pharmacy claims data contains PHI — it must be de-identified before sharing with the employer. The employer should receive aggregate, de-identified reports — not individual-level data. HIPAA prohibits using PHI for employment purposes. Confirm your PBM provides de-identified data and has a HIPAA business associate agreement.