pharmacy claims per member per month
rx_clms_pmpmDefinition
ISO-11179 Definition
The number of prescription drug claims divided by member months, used as a pharmacy utilization metric to track prescription drug utilization trends, benchmark against population norms by age and chronic disease burden, and measure the impact of pharmacy benefit design changes on prescription drug use. Rx claims PMPM varies significantly by population demographics and disease burden with Medicare populations having three to four times the prescription utilization of commercial populations.
Standard Abbreviation
rx_clms_pmpm
Category
Production DDL — FACT_PHARMACY_CLAIM
CREATE OR REPLACE TABLE FACT_PHARMACY_CLAIM (
rx_clm_key INTEGER NOT NULL -- surrogate key,
rx_clm_id VARCHAR(50) NOT NULL -- pharmacy claim ID,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
ndc_cd VARCHAR(11) -- national drug code,
drug_nm VARCHAR(255) -- drug name,
drug_gnrc_ind CHAR(1) -- generic indicator,
days_sply_cnt SMALLINT -- days supply count,
qty_dspnd DECIMAL(10,3) -- quantity dispensed,
rx_fill_dt DATE -- fill date,
formulary_tier SMALLINT -- formulary tier,
rx_cost_amt DECIMAL(10,2) -- total drug cost,
mbr_pay_amt DECIMAL(10,2) -- member pay amount,
plan_pay_amt DECIMAL(10,2) -- plan pay amount,
prior_auth_ind CHAR(1) -- prior auth required,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical pharmacy table. Convert to BigQuery or Databricks →
Why This Term Matters
Pharmacy data is among the most regulated and codified data in healthcare, governing controlled substances, PBM adjudication, and Medicare Part D reporting. A data engineer fluent in pharmacy terminology builds pipelines that correctly parse NDC codes, validate DEA numbers, and detect drug utilization anomalies before they reach compliance teams. Errors in pharmacy field definitions frequently trigger PBM contract disputes and CMS audit findings.
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