Stream: Da Vinci PDex Drug Formulary
Topic: MedicationKnowledge Years
Tushar Nair (Mar 18 2021 at 17:21):
The linkage to the 'List' (CoveragePlan is not just dependent on the Plan ID alone (There is an extension for Plan ID in the MedicationKnowledge resource in DaVinci). One has to also factor in the drug tier (there is an extension for that as well) and the year. From the source plan json we get a Plan with an ID containing a formulary with multiple tiers and Year(s) for which the information is true, e.g. 2020, 2021 etc.. A sample is shown below:
[
{
"plan_id_type": "HIOS-PLAN-ID",
"plan_id": "46944AL0280001",
"marketing_name": "Blue Choice Platinum for Business",
"summary_url": "https://www.test.com/b2020BlueChoicePlatinum",
"plan_contact": "HIMMachineReadableQuestions@test.org",
"years": [
2020
],
"network": [
{
"network_tier": "TIER-ONE"
}
],
"formulary": [
{
"drug_tier": "TIER-ONE",
"mail_order": true,
"cost_sharing": [
{
"pharmacy_type": "1-MONTH-IN-RETAIL",
"copay_amount": 10.0,
"copay_opt": "BEFORE-DEDUCTIBLE",
"coinsurance_rate": 0.0,
"coinsurance_opt": "NO-CHARGE"
},
Therefore ideally the medication knowledge resource should contain a drug with with plan id as well as drug-tier & the Year information for it to be successfully bound to the appropriate 'List' resource/CoveragePlan. Is this already discussed, if not is there a plan to introduce an extension for -'Years' in the MedicationKnowledge' resource. I t would be very helpful to have this extension for accurate linkage of the MedicationKnowledge resource to Lst resource. In the meantime , Using MedicationKnowledge.synonym seems to be a good placeholder to enter the 'Year' value.
Saul Kravitz (Mar 18 2021 at 17:43):
@Tushar Nair
Current Formulary IG (and the QHP formulary) addresses active plan and medications only.
There is no provision to tag years where information is valid.
Tushar Nair (Mar 18 2021 at 17:46):
Saul Kravitz thank you for the quick response. So if we have multiple years for which the medications and plans are valid, then what I am assuming is that we create as many instances of the List and MedicationKnowledge resource. Example I may have years 2021 and 2022. Then don't we need to link them correctly year wise?
Saul Kravitz (Mar 18 2021 at 17:58):
For the STU1.0.1 IG: I think you would need to define a distinct CoveragePlan(List) for each year (with a distinct business identifier), and a distinct FormularyDrug(MedicationKnowledge) for each RxNorm code in each CoveragePlan(List).
Tushar Nair (Mar 18 2021 at 19:33):
Saul Kravitz Thank you !
Last updated: Apr 12 2022 at 19:14 UTC
