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  1. FHIR Specification Feedback
  2. FHIR-36330

Provide more guidance for authenticated access

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Drug Formulary (FHIR)
    • 1.2.0
    • Pharmacy
    • Use Cases and Overview
    • 3.2
    • Hide

      Change Authenticated Access Section to:

      When accessing data through an authenticated API, the response for queries on InsurancePlan depends on whether the authenticated member has access to the plan in relation to their membership.  

      • For the [Payer Insurance Plan](StructureDefinition-usdf-PayerInsurancePlan.html), this is the overall plan or plans that the individual is a member of.
      • For [Formulary](StructureDefinition-usdf-Formulary.html), this means all Formularies that are generally available to the member. If the member is in a group, all group associated formularies are returned. If not in a group, all generally available formularies (that is, those that are not restricted to only one or more groups) are returned.

      Clients can determine the Formulary InsurancePlan(s) that the member is subscribed by first retrieving the Payer Insurance Plan(s) and identifying the Formulary(s) through the [Payer Insurance Plan InsurancePlan.coverage](StructureDefinition-usdf-PayerInsurancePlan-definitions.html#InsurancePlan.coverage:drug-coverage)

      .

      The following table indicates how the Formulary API should respond to requests when a Formulary Insurance plan (by resource reference) is specified and when it is not.

       

      InsurancePlan specified – GET by resource ID InsurancePlan reference not specified - Search
      Return plan if covered by insurer and included in group if member is part of a group
      If not, return 400
       Return all plans if covered by insurer and included in group if member is part of a group
      If none, return 200 

      Access to other profiled resources in this IG ([FormularyItem](StructureDefinition-usdf-FormularyItem.html) & [FormularyDrug]( StructureDefinition-usdf-FormularyDrug.html)) is not constrained by this IG.

      Server implementers SHALL make other profiled resources in this IG ([FormularyItem](StructureDefinition-usdf-FormularyItem.html), [FormularyDrug]( StructureDefinition-usdf-FormularyDrug.html)) associated to a member’s available plans available through authenticated access. This IG does not define restrictions on authenticated access to resources not associated with a member’s available plan or the [Plan Location]( StructureDefinition-usdf-InsurancePlanLocation.html) resource.

       

      Show
      Change Authenticated Access Section to: When accessing data through an authenticated API, the response for queries on InsurancePlan depends on whether the authenticated member has access to the plan in relation to their membership.   For the [Payer Insurance Plan] (StructureDefinition-usdf-PayerInsurancePlan.html), this is the overall plan or plans that the individual is a member of. For [Formulary] (StructureDefinition-usdf-Formulary.html), this means all Formularies that are generally available to the member. If the member is in a group, all group associated formularies are returned. If not in a group, all generally available formularies (that is, those that are not restricted to only one or more groups) are returned. Clients can determine the Formulary InsurancePlan(s) that the member is subscribed by first retrieving the Payer Insurance Plan(s) and identifying the Formulary(s) through the [Payer Insurance Plan InsurancePlan.coverage] (StructureDefinition-usdf-PayerInsurancePlan-definitions.html#InsurancePlan.coverage:drug-coverage) . The following table indicates how the Formulary API should respond to requests when a Formulary Insurance plan (by resource reference) is specified and when it is not.   InsurancePlan specified – GET by resource ID InsurancePlan reference not specified - Search Return plan if covered by insurer and included in group if member is part of a group If not, return 400  Return all plans if covered by insurer and included in group if member is part of a group If none, return 200  Access to other profiled resources in this IG ( [FormularyItem] (StructureDefinition-usdf-FormularyItem.html) & [FormularyDrug] ( StructureDefinition-usdf-FormularyDrug.html)) is not constrained by this IG. Server implementers SHALL  make other profiled resources in this IG ( [FormularyItem] (StructureDefinition-usdf-FormularyItem.html), [FormularyDrug] ( StructureDefinition-usdf-FormularyDrug.html)) associated to a member’s available plans available through authenticated access. This IG does not define restrictions on authenticated access to resources not associated with a member’s available plan or the [Plan Location] ( StructureDefinition-usdf-InsurancePlanLocation.html) resource.  
    • Corey Spears / Dave Hill: 9-0-0
    • Clarification
    • Compatible, substantive

    Description

      The authenticated access table is not as clear as it should be. Specifically, it does not address behavior specific to the payer insurance plan vs the formulary InsurancePlan.

      It does not address anticipated behavior for the FormularyItem or FormularyDrug (if there are any effects)

      Additionally, it is not clear that the PlanID column is meant as a search for "other" plans that the member is not currently enrolled in, to enable searches for plans available to the member.

      These issues need to be fixed.

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            corey_spears Corey Spears
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              Updated:
              Resolved: