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  1. FHIR Specification Feedback
  2. FHIR-30923

Matching QHP Formulary: per-plan information on a Formulary Drug should be 1..*

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Drug Formulary (FHIR)
    • 1.0.1
    • Pharmacy
    • Formulary Drug
    • Hide

      Address through a restructuring of the profiles included in the IG.

      • Change CoveragePlan profile on List to InsuracePlan
      • Add FormularyItem Profile on Basic with extensions moved from FormularyDrug profile
      • Enable linking multiple FormularyDrugs with multiple InsurancePlans through multiple FormularyItems pointing to a formulary InsurancePlan.
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      Address through a restructuring of the profiles included in the IG. Change CoveragePlan profile on List to InsuracePlan Add FormularyItem Profile on Basic with extensions moved from FormularyDrug profile Enable linking multiple FormularyDrugs with multiple InsurancePlans through multiple FormularyItems pointing to a formulary InsurancePlan.
    • Corey Spears / Scott Robertson: 12-0-0
    • Enhancement
    • Non-compatible

      Ref:  https://chat.fhir.org/#narrow/stream/179166-implementers/topic/US.20Drug.20Formulary

      In the QHP formulary upon which the PDex Formulary was (supposed to be) modeled, the per-plan info on each drug is 1..*.   

      For example:

      {
        "rxnorm_id": "209459",
        "drug_name": "Acetaminophen 500 MG Oral Tablet [Tylenol]",
        "plans": [
            {
                "plan_id_type": "HIOS-PLAN-ID",
                "plan_id": "12345XX9876543",
                "drug_tier": "GENERIC",
                "prior_authorization": false,
                "step_therapy": false,
                "quantity_limit": false
            },
            {
                "plan_id_type": "HIOS-PLAN-ID",
                "plan_id": "12345XX9876546",
                "drug_tier": "GENERIC",
                "prior_authorization": false,
                "step_therapy": false,
                "quantity_limit": false
            }
        ]
    },

      In the current formulary, only one association with plan/tier/prior-auth/step-therapy/quantity-limit is allowed.

            Unassigned Unassigned
            saul_kravitz Saul Kravitz
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved: