Define the relationship
Specify whether you need a PBM organization, plan administrator, pharmacy network or provider participation record.
PBMs & payer relationships
Know which relationship you’re looking at.
Pharmacy benefit managers help administer prescription drug benefits. That is a different relationship from a provider participating in a health plan. Keep those questions separate when building your research brief.
Start with available coverage
Ask about health plan, issuer and provider-network research. Availability must be confirmed for your account and deployment.
Avoid unsupported conclusions
Provider participation does not reveal a PBM contract, negotiated rebate, formulary or share of a practice’s revenue.
What the data can—and cannot—answer
- Plan and issuer records
- A starting point for health-plan research where records are available. These are not PBM ownership records.
- Provider-network participation
- An observed plan/provider connection. It does not establish current acceptance for a particular patient or service.
- PBM relationships and formularies
- A dedicated PBM relationship graph, formularies and rebate information are not currently offered here.
- Coverage requests
- Tell us the entities, relationships, geography and dates you need. We will confirm availability before proposing a dataset.
Before you get started
Can I download a complete PBM database here?
No. This page explains the coverage boundary and provides a way to discuss your requirements.
Does a plan record identify its PBM?
Not by itself. A PBM relationship needs its own evidence and should not be inferred from a plan or provider-network match.
What should I send for a coverage review?
Send the organization types, required fields, geography and intended use. Do not send patient records or sensitive patient information.