Uploaded image for project: 'FHIR Specification Feedback'
  1. FHIR Specification Feedback
  2. FHIR-32178

Add co-pay value for drugs not subject to deductible

    XMLWordPrintableJSON

Details

    • Change Request
    • Status: Published (View Workflow)
    • Medium
    • Resolution: Persuasive
    • US Da Vinci Drug Formulary (FHIR)
    • 1.0.1
    • Pharmacy
    • Qualifier of copay amount
    • Hide

      Add the following to the Qualifier of copay amount:

      Charge - the consumer always pays just the copay and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).

      Add the following to the Qualifier of coinsurance rate:

      Charge - the consumer always pays just the coinsurance and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).

      Show
      Add the following to the Qualifier of copay amount: Charge - the consumer always pays just the copay and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible). Add the following to the Qualifier of coinsurance rate: Charge - the consumer always pays just the coinsurance and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).
    • Dave Hill / Tim McNeil : 8 - 0 - 1
    • Correction
    • Compatible, substantive

    Description

      Notes from Da Vinci PDex meeting

      • Deductible - could be zero or could have a maintenance drug that is covered before the deductible, but others go through the deductible. 
      • Value that is missing is a charge value - drug not subject to deductible, but there is a deductible otherwise. (not free, but not subject to deductible)
        • "Charge" isn't clear - so something like "excluded from deductible" or "outside of.."
        • "not subject to deductible" - people liked this. 
      • Let's harmonize with the EOB. 
      • This is in the drug tier definition extension. 
      • Two uses: co-pay and co-insurance. 

      Attachments

        Issue Links

          Activity

            People

              Unassigned Unassigned
              dwhill David Hill
              Watchers:
              2 Start watching this issue

              Dates

                Created:
                Updated:
                Resolved: