Stream: Da Vinci PDex Drug Formulary
Topic: usdf-Network-extension value
Mark Scrimshire (Mar 30 2021 at 15:46):
@Saul Kravitz @Corey Spears A question from one of our clients about formulary for Medicaid.
the fhir path is List.extension.usdf-Network-extension.value . The description is "an array of networks within a plan". This is not applicable in the Maryland FFS Medicaid world. What is the proper Null Flavor attribute to use or is there something else that is more appropriate?
Saul Kravitz (Mar 30 2021 at 16:03):
Currently, this value is a string. There is no constraint on the string value. If it isn't relevant, I'd suggest "N/A".
@Corey Spears @Dave Hill This is another example where straight translation of the QHP formulary into FHIR didn't really work well. Ideally, the network cited here would provide a reference to a Network instance in a provider directory, right? Alternatively, if there is no such linkage, this is might be a vestigial appendix that could be excised.
Lloyd McKenzie (Mar 30 2021 at 16:04):
If it's possible for it to be not-applicable, it shouldn't be required in the first place...
Mark Scrimshire (Mar 30 2021 at 16:51):
That extension requires a string value to be submitted. Should we log a ticket to propose a change in cardinality to make List.extension a 3..* instead of 4..* and usdf-network-extension have a cardinality of 0..*
Saul Kravitz (Mar 30 2021 at 16:57):
@Mark Scrimshire Even if it is present, shouldn't it be a useful reference? (i.e., a reference to a Network in the Payer's provider directory).
What would the member do with a string reference to a Network by name?
Mark Scrimshire (Mar 30 2021 at 19:13):
I think the point is that there is no network to refer to for this particular situation.
Saul Kravitz (Mar 30 2021 at 21:11):
By all means document the issue with a tracker.
My point is that I think in the current design, it is meaningless in all cases.
For the near term (prior to any technical correction): just fill it with something.
Making it optional is arguably a breaking change (for the client).
If the field is going to remain, my suggestion is make it a useful hook for client software (if needed), or the member (I don't see why the member would ever care).
Saul Kravitz (Mar 31 2021 at 18:21):
https://jira.hl7.org/browse/FHIR-31672
Dave Hill (Mar 31 2021 at 21:40):
Do we know why it is not applicable for Maryland Medicaid FFS?
Bryan Briegel (Apr 05 2021 at 16:12):
I have a general question on the framework for a drug Formulary vs a Preferred Drug List. Is the question noted re: Maryland , known to be specific to that state, or Medicaid FFS in general? MA-PD plans are required to make accessible "(ii)Formulary data that includes covered Part D drugs, and any tiered formulary structure or utilization management procedure which pertains to those drugs." where Medicaid is required to make accessible "(4) Information about covered outpatient drugs and updates to such information, including, where applicable, preferred drug list information," I poked through the IG and I dont see references to "preferred drug lists" - just wondering on that, thx.
Saul Kravitz (Apr 06 2021 at 13:13):
Splitting this off to a separate thread....
Last updated: Apr 12 2022 at 19:14 UTC
