Difference between Payer and Pharmacy Medication History?

Payer claims data is a list of medications where a claim was filed. The Pharmacy Benefit Manager (PBM) is the payer and stores a list of medications specific to each patient. Given that a patient can be a member of more than one PBM, the PBM claims medication history is a comprehensive list of medications for a patient for each PBM. This data will only be retrieved for the last two years.

Pharmacy Fill data is a list of medications filled by a pharmacy for the patient. This list would be a superset of medications where the patient has filed a claim and for those paid out of pocket. This data is retrieved from any pharmacy in our network that has filled a prescription for the patient. This data is retrieved for the last year.

For more information, please see: How do I use Medication History?

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