Pharmacy Benefits Verification uses a data model that’s FHIR-CARIN and NCPDP aligned to store its data and make it interoperable. The pharmacy benefits verification data model supports drug manufacturers, providers, pharmacists, and healthcare organizations in determining pharmacy benefits coverage for the medications prescribed to the patients under a care program.
| Required Editions |
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| Available in: Lightning Experience Available in: Enterprise and Unlimited Editions with Health Cloud |
The pharmacy benefits verification objects are available to users with the Health Cloud Foundation and Manage Pharmacy Benefits Verification permission set. Available in API version 61.0 and later.
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CareBenefitVerifyRequest for Pharmacy Benefits Verification
Request for verification of benefits.
CareProgram for Pharmacy Benefits Verification
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.
CareProgramEnrollee for Pharmacy Benefits Verification
Represents a participant enrolled in a care program.
CareProgramProduct for Pharmacy Benefits Verification
Represents the affiliation between a care program and a care program product, care program provider, or both.
CoverageBenefit for Pharmacy Benefits Verification
Represents the benefits provided to a covered member by a purchaser’s plan.
CoverageBenefitItem for Pharmacy Benefits Verification
Represents a service covered by the insurance plan.
CoverageBenefitItemLimit for Pharmacy Benefits Verification
Represents expenditures, limits, coverage levels, eligibility, and exclusions for a specific benefit.
HealthcareProvider for Pharmacy Benefits Verification
Represents business-level details about the healthcare organization or the practitioner.
Medication for Pharmacy Benefits Verification
Represents detailed information about different medications.
MedicationRequest for Pharmacy Benefits Verification
Represents a request or order for the supply of medication, along with information about how it should be administered.
MemberPlan for Pharmacy Benefits Verification
Represents details about the insurance coverage for a member or subscriber.
PurchaserPlan for Pharmacy Benefits Verification
Represents the payer plan that a purchaser makes available to its members and members’ dependents.
Represents the unit of measures for care metrics and care observations. This object is available in API version 49.0 and later.
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