/**
* Medicaid Dataset Mappings
*
* Dataset IDs and access methods from data.medicaid.gov
* Source: DKAN platform (hybrid CSV + API approach)
*
* ARCHITECTURE:
* - Small datasets (<50 MB): CSV download + in-memory cache (NADAC, Enrollment)
* - Large datasets (>100 MB): DKAN API queries (Drug Rebate, Drug Utilization, Federal Upper Limits)
*
* DKAN API endpoint: https://data.medicaid.gov/api/1/datastore/query/{dataset-id}/0
*/
const DATASETS = {
// NADAC (National Average Drug Acquisition Cost)
NADAC_2024: {
id: '99315a95-37ac-4eee-946a-3c523b4c481e',
downloadUrl: 'https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost-12-25-2024.csv',
metadataUrl: 'https://data.medicaid.gov/api/1/metastore/schemas/dataset/items/99315a95-37ac-4eee-946a-3c523b4c481e',
name: 'NADAC (National Average Drug Acquisition Cost) 2024',
category: 'drug_pricing',
update_frequency: 'weekly',
description: 'Weekly NADAC pricing data for prescription drugs',
cacheTime: 24 * 60 * 60 * 1000, // 24 hours
estimatedSize: '123 MB',
estimatedRecords: '1,497,925',
accessMethod: 'csv' // CSV download + in-memory cache
},
// Enrollment & Eligibility
ENROLLMENT_SNAPSHOT: {
id: '6165f45b-ca93-5bb5-9d06-db29c692a360',
downloadUrl: 'https://download.medicaid.gov/data/pi-dataset-november-2025release.csv',
metadataUrl: 'https://data.medicaid.gov/api/1/metastore/schemas/dataset/items/6165f45b-ca93-5bb5-9d06-db29c692a360',
name: 'Medicaid and CHIP Eligibility Operations and Enrollment Snapshot Data',
category: 'enrollment',
update_frequency: 'monthly',
description: 'Monthly enrollment and eligibility processing data by state',
cacheTime: 7 * 24 * 60 * 60 * 1000, // 7 days
estimatedSize: '3.6 MB',
estimatedRecords: '10,098',
accessMethod: 'csv' // CSV download + in-memory cache
},
// Drug Rebate Program
DRUG_REBATE: {
id: '0ad65fe5-3ad3-5d79-a3f9-7893ded7963a',
downloadUrl: 'https://download.medicaid.gov/data/drugproducts3q_2025Updated11132025.csv',
metadataUrl: 'https://data.medicaid.gov/api/1/metastore/schemas/dataset/items/0ad65fe5-3ad3-5d79-a3f9-7893ded7963a',
name: 'Drug Products in the Medicaid Drug Rebate Program',
category: 'drug_pricing',
update_frequency: 'quarterly',
description: 'Active drugs reported by manufacturers under MDRP (NDC, unit type, FDA approval, innovator/non-innovator)',
cacheTime: 7 * 24 * 60 * 60 * 1000, // 7 days
estimatedSize: '291 MB',
estimatedRecords: '~3M+',
accessMethod: 'dkan_api' // DKAN API queries (too large for CSV)
},
// State Drug Utilization
DRUG_UTILIZATION: {
id: '61729e5a-7aa8-448c-8903-ba3e0cd0ea3c',
downloadUrl: 'https://download.medicaid.gov/data/sdud-2024-updated-dec2025.csv',
metadataUrl: 'https://data.medicaid.gov/api/1/metastore/schemas/dataset/items/61729e5a-7aa8-448c-8903-ba3e0cd0ea3c',
name: 'State Drug Utilization Data 2024',
category: 'utilization',
update_frequency: 'quarterly',
description: 'Drug utilization by state (NDC, prescriptions, dollars reimbursed) - aggregate level',
cacheTime: 7 * 24 * 60 * 60 * 1000, // 7 days
estimatedSize: '192 MB',
estimatedRecords: '5,284,306',
accessMethod: 'dkan_api' // DKAN API queries (too large for CSV)
},
// Federal Upper Limits
FEDERAL_UPPER_LIMITS: {
id: 'ce4cf49b-a21b-5a53-bbc3-509414940847',
downloadUrl: 'https://download.medicaid.gov/data/aca-federal-upper-limits-11242025.csv',
metadataUrl: 'https://data.medicaid.gov/api/1/metastore/schemas/dataset/items/ce4cf49b-a21b-5a53-bbc3-509414940847',
name: 'ACA Federal Upper Limits',
category: 'drug_pricing',
update_frequency: 'monthly',
description: 'FUL based on weighted average AMP for therapeutically equivalent multiple source drugs',
cacheTime: 7 * 24 * 60 * 60 * 1000, // 7 days
estimatedSize: '196 MB',
estimatedRecords: '2,085,934',
accessMethod: 'dkan_api' // DKAN API queries (too large for CSV, growing monthly)
},
// California Medicaid Formulary
CALIFORNIA_MEDICAID_FORMULARY: {
id: 'ca-medi-cal-formulary',
state: 'CA',
downloadUrl: 'https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/forms-and-information/cdl/Medi-Cal_Rx_Approved_NDC_List.xlsx',
name: 'California Medi-Cal Rx Approved NDC List',
category: 'formulary',
update_frequency: 'monthly',
description: 'California Medicaid formulary with NDC codes, PA requirements, and cost ceiling tiers (covers 15M beneficiaries - 20% of all Medicaid)',
cacheTime: 30 * 24 * 60 * 60 * 1000, // 30 days (monthly updates)
estimatedSize: '1.7 MB',
estimatedRecords: '40,326',
accessMethod: 'excel' // Excel download + in-memory cache
},
// Texas Medicaid Formulary
TEXAS_MEDICAID_FORMULARY: {
id: 'tx-vdp-formulary',
state: 'TX',
downloadUrl: 'https://www.txvendordrug.com/sites/default/files/docs/data--formulary--drug.txt',
name: 'Texas Vendor Drug Program Formulary',
category: 'formulary',
update_frequency: 'weekly',
description: 'Texas Medicaid formulary with NDC codes, PA requirements, pricing data, and multi-program eligibility (covers 4.4M beneficiaries - 6% of all Medicaid)',
cacheTime: 7 * 24 * 60 * 60 * 1000, // 7 days (weekly updates)
estimatedSize: '1.63 MB',
estimatedRecords: '4,701',
accessMethod: 'text' // Pipe-delimited text download + in-memory cache
},
// New York Medicaid Formulary
NEW_YORK_MEDICAID_FORMULARY: {
id: 'ny-medicaid-formulary',
state: 'NY',
downloadUrl: 'https://docs.emedny.org/ReimbursableDrugs/MedReimbDrugsFormulary.csv',
name: 'New York Medicaid Pharmacy List of Reimbursable Drugs',
category: 'formulary',
update_frequency: 'daily',
description: 'New York Medicaid formulary with NDC codes, MRA pricing, PA requirements, and quantity limits (covers 6.5M beneficiaries - 9% of all Medicaid)',
cacheTime: 24 * 60 * 60 * 1000, // 24 hours (daily updates)
estimatedSize: '4.97 MB',
estimatedRecords: '37,687',
accessMethod: 'csv' // Standard CSV download + in-memory cache
},
// Ohio Medicaid Formulary
OHIO_MEDICAID_FORMULARY: {
id: 'oh-spbm-formulary',
state: 'OH',
downloadUrl: 'https://spbm.medicaid.ohio.gov/SPDocumentLibrary/DocumentLibrary/Machine%20Readable%20Files/Machine%20Readable%20Formulary%2011.24.2025.json',
name: 'Ohio SPBM Unified Preferred Drug List',
category: 'formulary',
update_frequency: 'biweekly',
description: 'Ohio Medicaid formulary with NDC codes, PA requirements, step therapy, and quantity limits (covers 3.1M beneficiaries - 4% of all Medicaid)',
cacheTime: 14 * 24 * 60 * 60 * 1000, // 14 days (biweekly updates)
estimatedSize: '34 MB',
estimatedRecords: '76,627',
accessMethod: 'json' // JSON download + in-memory cache
},
// Illinois Medicaid Formulary
ILLINOIS_MEDICAID_FORMULARY: {
id: 'il-hfs-pdl',
state: 'IL',
downloadUrl: 'https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/pdl10242025.xlsx',
name: 'Illinois HFS Preferred Drug List',
category: 'formulary',
update_frequency: 'quarterly',
description: 'Illinois Medicaid formulary (enriched via cross-state NDC matching from CA/NY/OH - 51-52% coverage, covers 2.9M beneficiaries - 4% of all Medicaid)',
cacheTime: 90 * 24 * 60 * 60 * 1000, // 90 days (quarterly updates)
estimatedSize: '222 KB',
estimatedRecords: '5,729',
accessMethod: 'excel', // Excel download + cross-state enrichment
enrichmentStrategy: 'cross-state', // Uses CA/NY/OH formularies for NDC codes
enrichmentCoverage: 0.52 // 51-52% of drugs get NDC codes via cross-state matching (OH adds medical devices)
}
};
/**
* Get dataset configuration by category and purpose
*/
function getDataset(category, purpose) {
switch (category) {
case 'nadac':
case 'drug_pricing':
if (purpose === 'rebate') {
return DATASETS.DRUG_REBATE;
} else if (purpose === 'ful') {
return DATASETS.FEDERAL_UPPER_LIMITS;
} else if (purpose === 'ca_formulary') {
return DATASETS.CALIFORNIA_MEDICAID_FORMULARY;
} else if (purpose === 'tx_formulary') {
return DATASETS.TEXAS_MEDICAID_FORMULARY;
} else if (purpose === 'ny_formulary') {
return DATASETS.NEW_YORK_MEDICAID_FORMULARY;
}
return DATASETS.NADAC_2024;
case 'enrollment':
return DATASETS.ENROLLMENT_SNAPSHOT;
case 'utilization':
return DATASETS.DRUG_UTILIZATION;
case 'formulary':
// If purpose is a state code, return that state's formulary
if (purpose === 'CA') {
return DATASETS.CALIFORNIA_MEDICAID_FORMULARY;
} else if (purpose === 'TX') {
return DATASETS.TEXAS_MEDICAID_FORMULARY;
} else if (purpose === 'NY') {
return DATASETS.NEW_YORK_MEDICAID_FORMULARY;
} else if (purpose === 'OH') {
return DATASETS.OHIO_MEDICAID_FORMULARY;
} else if (purpose === 'IL') {
return DATASETS.ILLINOIS_MEDICAID_FORMULARY;
}
// Default to California for backward compatibility
return DATASETS.CALIFORNIA_MEDICAID_FORMULARY;
default:
throw new Error(`Unknown dataset category: ${category}`);
}
}
/**
* Get formulary dataset by state code
* @param {string} state - State code (CA, TX, NY, OH, IL)
* @returns {Object} Dataset configuration
*/
function getFormularyByState(state) {
const stateUpper = state.toUpperCase();
const formularyDatasets = Object.values(DATASETS).filter(ds =>
ds.category === 'formulary' && ds.state === stateUpper
);
if (formularyDatasets.length === 0) {
throw new Error(`No formulary data available for state: ${state}`);
}
return formularyDatasets[0];
}
/**
* Get all datasets by category
*/
function getDatasetsByCategory(category) {
return Object.values(DATASETS).filter(ds => ds.category === category);
}
/**
* List all available datasets
*/
function listDatasets() {
return Object.entries(DATASETS).map(([key, dataset]) => ({
key,
...dataset
}));
}
module.exports = {
DATASETS,
getDataset,
getFormularyByState,
getDatasetsByCategory,
listDatasets
};
