2021-03-19 PDex Meeting

Da Vinci April Education Session

Da Vinci Education & FHIR Implementation Event by HL7 - April 26 - 30

Register Here - Early Bird Registration by 4/5/21

Any questions?  

0005 - Conversation to add to the discoverable end points work as part of FAST  - standard API and IG for access to end points.  the capability statements 

Each end point (two sperate servers) with capability statements - PBM provided the Pharmacy directory. 

We could also have both on one server with single end point; one server with multiple end points with a hit that drives how the end point behaves

Multiple capability statements gets confusing, no single way to see what all the capabilities of an organization overall are, it's per server, per end point. Searching in provider directory by searching the

Why is pharmacy split out?  what about other carve outs... others like Mental health, etc. 

Rule says: If a payer has a provider network, regardless of if it's served by a carve out or not, then it should be included in the directory. 

PBM is a very common one and per the rule, it's ok to have two separate directories. 

Send in a query parameter to distinguish which kind of instance to do your query against.  within a single directory, they are separated by health care service... different directories/ end point by PBM and by payer.  

• search by service
• not up to the client to distinguish 

Does the 340B Pharmacy program - does the rule cover that?  

• The Rule has nothing to do with rebating in Medicaid.

Summary - the mental health and over carve outs would be included in the main directory.

Recap of above:

• Add additional bullet to reference the directory capability that would use codable concepts to help identify the different types of directory end points. Discovery of end point - how would you find if there is 1 or 2 directories? 
  • Instructions Payers will post will be indexed and discoverable by search engines.   

Reviewed and finalized 0006 and 0007 as well. 

FHIR-31579 - Getting issue details... STATUS  - 

Proxy NDC being used to fill in RXNorm.

When submissions go, there is an NDC that is used to represent that particular drug.  The proxy NDC, defined by CMS, can change so would have to change it. 

• would you split where you were suplying the RxNorm.
• Once you send the NDC code, you can't just remove it. 
• Could create an inversion to allow you to include them, but historical vs. current challenge.  
• You'd need to inactivate it in the value set, not just delete.  

If change to extensible, it allows for new drugs without RxNorm codes to use NDC codes, then when it's available, it would be updated to the RxNorm. 

The binding says what needs to be present.  may want ot set rules around timing from RxNorm code publication and the time you want it updated in your registry.  The bindging sets the expectation.  

NDC code not in value set just in the coding. 

Wouldn't have RxNorm - change to extensible. 

Flow: 

• Drug is born
• Create with NDC code
• then RxNorm code is created 
• Then it has both Ids and lives on. 

Primary purpose of the formulary is to:

• allow therapeutic alternatives for lower cost drugs.
• intent for shopping experience to decide on the plan you want based on the tier your drugs were in.  
• Want this to be the current view of the world.

Extensible, if no RXNorm exists, you can you anything (PBM, etc.)

Enteral nutrition doesn't have an RxNorm code. 

Cardinality would stay the same.  

Certain NDC codes have 

Summary next steps:  Make it extensive and provide some guidance.  Next Step: David Hill  will write it down and bring it to Pharmacy review.  

• Technical Correction: Express one thing, but messed it up in the writing. 
• Intent was to describe all drugs in formulary - made the mistake of assuming RxNorm codes are there, so we are now improving it. 
• It's a substantive change  - This would likely fall into an STU Update.

PDex IG Links and Updates

PDex Supplemental Guides

PDex IG Companion Guide - Laboratory Reporting Resources

FAQ Review Cont. and Implementer Support

Consent Discussion Cont. (if updates from Architecture Group)

Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0513.xlsx

DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx

Find initial questions and corresponding answers shared from our colleagues at CMS here

• Links to Published IGs

• PDex STU 1.0.0
• Plan Net STU 1.0.0
• Formulary - STU 1.0.1