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  1. FHIR Specification Feedback
  2. FHIR-42930

Two different binding strengths are provided for Drug Tier on Plan Level v/s Drug Level

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci Drug Formulary (FHIR)
    • 2.0.0
    • Pharmacy
    • Use Cases and Overview
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      The required binding strength was done in error. It should have been extensible.

       

      Loosen binding strength on PayerInsurancePlan.plan[drug-plan].specificCost.benefit.type from required to extensible

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      The required binding strength was done in error. It should have been extensible.   Loosen binding strength on PayerInsurancePlan.plan [drug-plan] .specificCost.benefit.type from required to extensible
    • Melva Peters / Jose Costa Teixeira : 7-0-1
    • Correction
    • Non-substantive

    Description

      In Formulary IG 2.0, the Payer Insurance Plan Profile (InsurancePlan Resource), which represent plan coverage level information, has Drug Tier ID (path- InsurancePlan.plan:drugplan: benefit.type), the Binding of the field is shown as required. Please refer screenshot 

       

      Where as in the Formulary Item Profile (Basic Resource), which represents Formulary  Drug level information, has Drug Tier Binding as extensible. Refer the screenshot.

       

      Question 1: Is there a reason why 2 different binding strengths are provided for Drug Tier on Plan Level v/s Drug Level ?

       

      Point: 

      In Formulary IG 1.0, the Drug Tier ID binding was extensible. Thus we added custom options to match what is being currently offered by the organization.

      For example: 

      Tier 1 - "Generic and Brand"

      Which means a single tier for a plan offers both Generic and Brand Formulary Drugs.

      Question 2: Thus, is there a way we can provide custom drug tier options on the Plan Level in Formulary IG 2.0 under Payer Insurance Plan ?

       

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            Unassigned Unassigned
            ravals Sanket Raval
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