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Total drug cost (Part D)

This variable is the total cost of the prescription drug event and is taken directly from the original PDE. It is the sum of the following components: the ingredient cost (INGRDNT_CST_PD_AMT), the dispensing fee (DSPNSNG_FEE_PD_AMT), the sales tax, if any (TOT_AMT_ATTR_SLS_TAX_AMT), and the vaccine administration fee, if any (VCCN_ADMIN_FEE_AMT, included starting in 2010).

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.item.adjudication.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication'
  ) and
    category.coding.where(code = 'TOT_RX_CST_AMT')
).amount.value
Coverage / Claim Type
  • Pharmacy
Sources
  • DDPS
Derived
True
Profiles
  • Regular
  • CMS

Example 

45.5

Notes

Derived using the sum of CLM_LINE_INGRDNT_CST_AMT, CLM_LINE_SRVC_CST_AMT, CLM_LINE_SLS_TAX_AMT, and CLM_LINE_VCCN_ADMIN_FEE_AMT. TOT_RX_CST_AMT is also set on the EOB's total with fhirPath ExplanationOfBenefit.total.where(category.coding.where(system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication' and code='submitted').exists() and category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='TOT_RX_CST_AMT').exists()).amount.value

Mappings

CCW
  • TOT_RX_CST_AMT

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