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  1. FHIR Specification Feedback
  2. FHIR-26504

Some payers consider [DUR info] important information to get patients on more clinically appropriate alternatives…

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    Details

    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Not Persuasive with Modification
    • Specification:
      US CARIN Real-time Pharmacy Benefit Check (RTPBC) (FHIR)
    • Work Group:
      Pharmacy
    • Related Page(s):
      Consumer vs provider RTPBC
    • Grouping:
    • Resolution Description:
      Hide

      Add content to the Consumer vs provider RTPBC page explaining why certain content returned in the provider-focused RTPBC messaging is not included the consumer-focused version.

      Information that is out of scope of the consumer-focused exchange
      In line with the goals and audience of this exchange, response information was either included or excluded from the specification based on whether it represents coverage or cost information relevant to the patient.

      For example, in the primary consumer use case, the patient's medication has already been prescribed and the practitioner has already considered potential contraindications and other factors--ultimately deciding to move ahead with the therapy. Because Consumer RTPBC does not seek to inform the prescribing decision, but instead provide the consumer with cost and coverage information after that decision is made, drug utilization review (DUR) and restricted opiod prescriber information is not included in the response.

      Likewise, because the patient is the user of this exchange's information, the response does not return "cost to plan" data returned by other standards to be considered during the prescribing process.

      Future versions of the guide will reflect feedback from implementers, and content will likely evolve over time.

      -----

      In addition, add footnotes to the following elements in the table on this page, noting that the elements are not included in this version of the IG, but are being considered for future versions:

      • Restricted Prescriber
      • Maximums and Limitations
      • Drug Utilization Review (DUR) 

       

      Show
      Add content to the Consumer vs provider RTPBC page explaining why certain content returned in the provider-focused RTPBC messaging is not included the consumer-focused version. Information that is out of scope of the consumer-focused exchange In line with the goals and audience of this exchange, response information was either included or excluded from the specification based on whether it represents coverage or cost information relevant to the patient. For example, in the primary consumer use case, the patient's medication has already been prescribed and the practitioner has already considered potential contraindications and other factors--ultimately deciding to move ahead with the therapy. Because Consumer RTPBC does not seek to inform the prescribing decision, but instead provide the consumer with cost and coverage information after that decision is made, drug utilization review (DUR) and restricted opiod prescriber information is not included in the response. Likewise, because the patient is the user of this exchange's information, the response does not return "cost to plan" data returned by other standards to be considered during the prescribing process. Future versions of the guide will reflect feedback from implementers, and content will likely evolve over time. ----- In addition, add footnotes to the following elements in the table on this page, noting that the elements are not included in this version of the IG, but are being considered for future versions: Restricted Prescriber Maximums and Limitations Drug Utilization Review (DUR)   
    • Resolution Vote:
      Frank McKinney / Daniel Zhang : 12-0-0
    • Change Category:
      Clarification
    • Change Impact:
      Non-substantive
    • Applied for Version:
      0.1.0

      Description

      Some payers consider this important information to get patients on more clinically appropriate alternatives. It can include safety alerts based on a patient’s medication profile or allergies.

      Instead of removing items from the standard, it would be better to leave it to the application to decide whether and how they want to display the information.

      Existing Wording:

      Response > Alternative medication > Drug utilization review (DUR) is in NCPDP, but not in this FHIR IG.

      Proposed Wording:

      Include DUR in the Response.

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              Assignee:
              Unassigned Unassigned
              Reporter:
              dzhang Daniel Zhang
              Request in-person:
              Daniel Zhang
              Watchers:
              3 Start watching this issue

                Dates

                Created:
                Updated:
                Resolved:
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