Stream: Da+Vinci+PDex+Plan-Net
Topic: Payer Pharmacy Networks - Contract Types
Kate Dech (Aug 27 2020 at 14:15):
@Gail Kocher @Robert Dieterle @Robert McClure @Saul Kravitz :
As a PBM, we have distinct contracts for standard retail, but we also have extended-supply retail (up to a 90 day fill, often with better pharmacy or member rates), and preferred retail and preferred ESN. These are often key elements for searching or filtering results by. If we use the OrganizationAffiliation.specialty element for representing the contract, there is a taxonomy code for retail. But it is a required binding and so we are unable to add addition qualifications to the type of retail. Has this been brought up? This is common across PBMs so I would think we would want a consistent element/way of denoting this. If we are using the .specialty element, it feels like it should be an extension directly on one taxonomy code.
Here's the type of contracts/networks that we support in our directories today:
Standard Retail - Taxonomy 3336C0003X Community/Retail Pharmacy
Preferred Retail - Taxonomy 3336C0003X Community/Retail Pharmacy + a Preferred Indicator
Standard Extended Supply/90 Day Retail - Taxonomy 3336C0003X Community/Retail Pharmacy + an Extended Supply Indicator
Preferred Extended Supply/90 Day Retail - Taxonomy 3336C0003X Community/Retail Pharmacy + an Extended Supply Indicator + a Preferred Indicator
Standard Mail Order - Taxonomy 3336M0002X Mail Order Pharmacy
Preferred Mail Order- Taxonomy 3336M0002X Mail Order Pharmacy + a Preferred Indicator
Specialty - Taxonomy 3336S0011X Specialty Pharmacy
Specialty - [Specific Disease/Drug, like Hemophilia] - Taxonomy 3336S0011X Specialty Pharmacy + Disease Specific Indicator + Description
Specialty-Limited Distribution (*likely not needed at this time but may be needed payer to provider) - Taxonomy 3336S0011X Specialty Pharmacy + LD indicator
Long Term Care - Taxonomy 3336L0003X Long Term Care Pharmacy
Home Infusion - Taxonomy 3336H0001X Home Infusion Therapy Pharmacy
Saul Kravitz (Aug 27 2020 at 14:24):
@Kate Dech do you have time to discuss next week? That would prob be more effective. Saul@mitre.org
Robert McClure (Sep 09 2020 at 21:16):
Did this get discussed?
Saul Kravitz (Sep 09 2020 at 21:50):
Yes. see my summary e-mail (probably 3m down in the stack)...
Last updated: Apr 12 2022 at 19:14 UTC
