Stream: Da Vinci PDex Drug Formulary
Topic: mailOrder extension
Shamil Nizamov (Nov 26 2020 at 15:11):
What is the business meaning of the usdf-DrugTierDefinition/mailOrder?
Saul Kravitz (Nov 30 2020 at 16:05):
As per: https://github.com/CMSgov/QHP-provider-formulary-APIs:
Does the formulary cover mail order? - (Values: true or false)
Shamil Nizamov (Dec 01 2020 at 15:02):
Saul Kravitz said:
As per: https://github.com/CMSgov/QHP-provider-formulary-APIs:
Does the formulary cover mail order? - (Values: true or false)
According to this API, "Organizations must post ... accessible to the public" - is there any example of the payer's site to download such jsons?
Also, sub-types such as Network or Formulary list some elements and rest is under etc., where to find a complete list of these etc. or is it payers specific?
Saul Kravitz (Dec 01 2020 at 15:38):
@Shamil -- I couldn't find a complete list, but here is a list http://www.nber.org/cciio/marketplace-puf/2016/machine-readable-url-puf.xlsx from 2016.
Could you expand on your question: "Also, sub-types such as Network or Formulary list some elements and rest is under etc., where to find a complete list of these etc. or is it payers specific?"
Shamil Nizamov (Dec 01 2020 at 19:51):
Could you expand on your question: "Also, sub-types such as Network or Formulary list some elements and rest is under etc., where to find a complete list of these etc. or is it payers specific?"
I meant that the complete value sets for network_tier and drug_tier are not listed. E.g., if I take the network_tier, could it be anything else other than PREFERRED or NON-PREFERRED?
Saul Kravitz (Dec 02 2020 at 18:50):
Where the QHP formulary has an enumerated list with etc at the end, we have a value set with an extensible binding. For example drug_tier. Extensible means you can use something else if your concept isn't covered in the list provided.
network_tier is defined in the QHP documentation for use with providers, so does not appear in the formulary IG.
Shamil Nizamov (Jan 11 2021 at 15:03):
Saul Kravitz said:
Shamil -- I couldn't find a complete list, but here is a list http://www.nber.org/cciio/marketplace-puf/2016/machine-readable-url-puf.xlsx from 2016.
@Saul Kravitz: Can the same data as in this spreadsheet (which is great) be retrieved from X12 274 (Healthcare Provider Information) message or is that a different beast?
Saul Kravitz (Jan 11 2021 at 17:30):
I'm not familiar with that one.
There will be a discussion of Endpoint directories at the connectathon.
Last updated: Apr 12 2022 at 19:14 UTC
