FHIR Chat · US Drug Formulary

The FormularyDrug mentions that within the extension for a drug there can be one plan, one drug_tier,etc (other extensions) information associated
... usdf-PlanID-extension S 1..1 string
... usdf-DrugTierID-extension S 1..1 CodeableConcept
But when we look at the QHP doc based on which this IG has been developed: https://github.com/CMSgov/QHP-provider-formulary-APIs
for a drug there can be multiple plan_id and multiple drug_tier
{
"rxnorm_id": "248656",
"drug_name": "Azithromycin 500 MG Oral Tablet [Zithromax]",
"plans": [
{
"plan_id_type": "HIOS-PLAN-ID",
"plan_id": "12345XX9876543",
"drug_tier": "GENERIC",
"prior_authorization": false,
"step_therapy": false,
"quantity_limit": true,
"years": [2016]
},
{
"plan_id_type": "HIOS-PLAN-ID",
"plan_id": "12345XX9876546",
"drug_tier": "GENERIC",
"prior_authorization": false,
"step_therapy": false,
"quantity_limit": false,
"years": [2017]
}
]
How to resolve this while implementing the FormularyDrug profile?

Lloyd McKenzie (Feb 02 2021 at 14:40):

@Jean Duteau @Melva Peters

Melva Peters (Feb 02 2021 at 14:42):

@Dave Hill @Saul Kravitz

Saul Kravitz (Feb 02 2021 at 15:08):

@Chetana Nayyar
Unfortunately (from the perspective of claimed alignment of the Formulary IG with the QHP formulary), you are correct.
Here is an example:

{
        "rxnorm_id": "209459",
        "drug_name": "Acetaminophen 500 MG Oral Tablet [Tylenol]",
        "plans": [
            {
                "plan_id_type": "HIOS-PLAN-ID",
                "plan_id": "12345XX9876543",
                "drug_tier": "GENERIC",
                "prior_authorization": false,
                "step_therapy": false,
                "quantity_limit": false
            },
            {
                "plan_id_type": "HIOS-PLAN-ID",
                "plan_id": "12345XX9876546",
                "drug_tier": "GENERIC",
                "prior_authorization": false,
                "step_therapy": false,
                "quantity_limit": false
            }
        ]
    },

Dave Hill (Feb 02 2021 at 15:34):

@Chetana Nayyar A Jira ticket has been filed to allow more than one usdf-PlanID-extension per FormularyDrug. I will file another ticket for allowing more than one usdf-DrugTierID-extension per FormularyDrug. Feel free to join us on the Da Vinci PDex calls where we answer implementer questions and talk about issues like this in detail. https://global.gotomeeting.com/join/514633709

Thanks!
Dave

Chetana Nayyar (Feb 02 2021 at 16:35):

@Dave Hill Thanks for quick turn around.
similarly the other fields within the block is repeating for a same drug; Does this require separate JIRA as well?
. usdf-PriorAuthorization-extension S 0..1 boolean
... usdf-StepTherapyLimit-extension S 0..1 boolean
... usdf-QuantityLimit-extension S 0..1 boolean

Chetana Nayyar (Feb 03 2021 at 11:25):

Is there any timeline when these changes will be reflected?

Saul Kravitz (Feb 04 2021 at 17:18):

See continuation of this discussion here -- https://chat.fhir.org/#narrow/stream/197730-Da-Vinci.20PDex.20Drug.20Formulary/topic/Matching.20QHP.20Formulary.3A.20per-plan.20information.20on.20a.20Formulary

Last updated: Apr 12 2022 at 19:14 UTC

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FHIR Chat · US Drug Formulary · implementers

Stream: implementers

Topic: US Drug Formulary