The Medicare program provides health insurance coverage to more than 60 million people.

Pharmaceuticals

The Centers for Medicare and Medicaid Services (CMS) contracts with private insurance companies, known as Medicare Prescription Drug Plan (PDP) sponsors, to provide prescription drug coverage for enrollees.

The Bipartisan Budget Act of 2018 (BBA) requires the development of a process to share Medicare claims data with PDP sponsors. The Final Rule provides additional detail on the purposes and limitations on the use of data, the data request process, and data extract content.

In response to the BBA, CMS has developed an Application Programming Interface (API) known as the AB2D API. The AB2D API securely provides stand-alone PDP sponsors with Medicare Parts A and B claims data for their active enrollees. PDP sponsors will be able to utilize this claims data to promote the appropriate use of medications and to improve health outcomes for their beneficiaries. The bulk claims data provided by the AB2D API is formatted in Fast Healthcare Interoperability Resources (FHIR) a standard for exchanging healthcare information electronically.