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  1. FHIR Specification Feedback
  2. FHIR-30925

Need a Plan-Specific MailOrder Flag on Formulary Drug

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    • Change Request
    • Status: Published (View Workflow)
    • Medium
    • Resolution: Persuasive
    • US Da Vinci Drug Formulary (FHIR)
    • 1.0.1
    • Pharmacy
    • Formulary Coverage Plan [deprecated]
      Formulary Drug
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      A boolean MailOrder extension will be added to the FormularyDrug profile.  The MailOrder extension value in FormularyDrug overrides the value of the value MailOrder field in CoveragePlan.  This will allow the payer to specify mail order capabilities on a per drug basis within a plan instead of just at the plan level.

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      A boolean MailOrder extension will be added to the FormularyDrug profile.  The MailOrder extension value in FormularyDrug overrides the value of the value MailOrder field in CoveragePlan.  This will allow the payer to specify mail order capabilities on a per drug basis within a plan instead of just at the plan level.
    • Dave Hill / Corey Spears : 13-0-0
    • Enhancement
    • Compatible, substantive

    Description

      Ref: https://chat.fhir.org/#narrow/stream/197730-Da-Vinci.20PDex.20Drug.20Formulary/topic/Mail.20Order.20Question

      "We’re currently mapping a formulary to Coverage Plan (List) and FormularyDrug (MedicationKnowledge). The CoveragePlan profile has the mail order indicator (Yes/No) and it appears to be required under the usdf-DrugTierDefinition-extension. However, mail order is not a “plan-level” attribute. It is an attribute of the drug. e.g. I’m on Medicare Advantage plan and I can get Atorvastatin through mail order but I can’t get Adempas via mail order. Both drugs are in the same formulary. Has anyone come across this issue and, if so, how did you handle it?"

      The current IG (based directly on the QHP formulary) only allows specification of mail order at the plan-level, as you noted. There is no facility to identify FormularyDrugs that do (not) have mail order options. 

       

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            saul_kravitz Saul Kravitz
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              Updated:
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