Details
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Change Request
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Resolution: Persuasive with Modification
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Medium
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US Da Vinci Drug Formulary (FHIR)
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2.0.1
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Pharmacy
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Payer Insurance Plan
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Queries
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5.1
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Description
The Authenticated API access method described in the 3.3.1 Authenticated section of the PDex US Drug Formulary 2.0.1 - STU2 Use Cases and Overview page appears to indicate that authenticated API query responses should limit the set of InsurancePlan resources returned to only "the overall plan or plans that the individual is a member of"/only "the plans the authenticated member has access to in relation to their membership". However, given the fact that the InsurancePlan resource profiled by Payer Insurance Plan is at the insurance "product" grain vs. the "plan" grain, and the 1..* cardinality of the Payer Insurance Plan InsurancePlan.plan element, how would a PDex Drug Formulary client (or FHIR only server) know which InsurancePlan.plan entry or entries the individual "is a member of"? It seems like both clients and servers would benefit from the incorporation of a profile on the Coverage resource & an enhancement to the Payer Insurance Plan profile (e.g., InsurnacePlan.plan:drug-plan.identifier 1..) to bridge the gap between authenticated user and the InsurancePlan.plan{*} entry or entries that individual "is a member of" or "has access to in relation to their membership".
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