FHIR Chat · Patient Specific Drug Formulary? · Da Vinci PDex Drug Formulary

Stream: Da Vinci PDex Drug Formulary

Topic: Patient Specific Drug Formulary?

Pegeen Ladeau (Jan 15 2021 at 20:03):

Is there a Draft STU for Drug Formulary to make it patient specific. Or is it Open API like Plan-Net?

I also understood on our meeting the other day that there is overlap with other Da Vinci patient specific profiles or IGs where maybe this formulary information would also be returned and making Drug Formulary redundant to a patient specific scenario (but not for a "shopping" example, of course!)?

I also was thinking about the Use Cases you presented @Dave Hill . Though out of scope, it says that patients may pull meds form EHR and then look them up. Could they also pull meds from their payer(s) and do the same?

Pegeen Ladeau (Jan 19 2021 at 21:07):

I think I figured out the answer to my question myself. I believe it is the Consumer Real-Time Pharmacy Benefit Check that was a patient-specific IG similar to Drug Formulary (but not included in CMS Final Rules) http://hl7.org/fhir/us/carin-rtpbc/index.html

Saul Kravitz (Jan 19 2021 at 21:54):

I think there are two scenarios:
1) Patient specific and benefits specific -- this is the RTPBC scenario. What does a specific RX, cost a specific patient, through a specific channel, given their pharmacy benefit and the state of their deductibles, etc.
2) Plan-level, but specific to the patient's plan -- this is the scenario for the Patient Access API. What are the plan-level costs for a specific Rx on the member's plan, and what alternatives are available (optional). The Formulary IG doesn't provide any specific support for this use case, so it is up to the client of the API to make queries that are constrained to the coverage plan associated with the member.