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Submitting WG/Project/Implementer Group

Pharmacy WG / DaVinci


Track Resources


General CMS Connectathon Participant Information:

Justification and Objectives

This project defines a FHIR interface to a health insurer's drug formulary information for patients/consumers. A drug formulary is a list of brand-name and generic prescription drugs a health insurer agrees to pay for, at least partially, as part of health insurance coverage. Drug formularies are developed based on the efficacy, safety and cost of drugs. The primary use cases for this FHIR interface enable consumers/patients to understand the costs and alternatives for drugs that have been prescribed, and to compare their drug costs across different insurance plans.  The drug formulary IG was successfully balloted for Standard for Trial Use (STU) ballot, and is undergoing final reconciliation.

The objectives of the hackathon are:

  • Test and gather feedback on the design and implementation feasibility of the drug formulary model and its FHIR Implementation Guide.
  • Identify areas of improvement and expansion of the drug formulary model to future use cases.
  • Foster mindshare and innovation ideas on potential applications using the drug formulary

This track will use the R4 version of FHIR.

Clinical input requested (if any)

None.

Related tracks

Da Vinci Payer Data Exchange

Da Vinci PDex Plan-Net

Proposed Track Lead

Saul Kravitz (saul@mitre.org).

David Hill  (dwhill@mitre.org). 

Expected participants

Potential producers (health plans) and consumers (3rd party application developers) of formulary data.

  • Josh Lamb (UPMC)
  • Barbara Valeno (Aetna)
  • Usha Ramaswamy (Aetna)
  • Siarhei Bartoshyk (Cigna)








Track Orientation

A webinar will be hosted on TBD to share further participation information about this track.

The track kickoff presentation from 11/15 can be see here:

Local Requester (Client)

An application that can query a FHIR server implementing the Formulary IG in support of provider or consumer use cases.

Available Clients

Drug Formulary  (Server)

A server that makes drug formulary data from a payers plan(s) available.

Available Servers

Scenarios

See the use cases section of the IG.

Scenario 1 :  Medication Copays under Insurance Plan

Action:   Query Formulary content for list of medications

Precondition:  Determine list of medication for the patient

Success Criteria:  Display medication list with copay information to patient.

Bonus point:   None

Scenario 2 : Shopping for Health Plans

Action:  Query formulary content of multiple drug formularies for a list of medications

Precondition:  Determine list of medication for the patient

Success Criteria:   Compare costs for medication list for multiple insurance plans

Bonus point:  None


TestScript(s)

Touchstone Tests are found at: Touchstone_DaVinci_PDexFormulary_Scripts

Please create a Touchstone user account (free) associated to the DaVinci organization if you have not already in order to run your systems through the test scripts.

Security and Privacy Considerations

No security or privacy considerations.   Data is not patient-related.



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