PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID
1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?
No
1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?
No
1e. Today's Date
1f. Name of standard being reaffirmed
1g. Project Artifact Information
1h. ISO/IEC Standard to Adopt
1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption?
1j. Unit of Measure
2a. Primary/Sponsor WG
Payer/Provider Information Exchange
2b. Co-Sponsor WG
Health Care Devices
2c. Co-Sponsor Level of Involvement
Request formal content review prior to ballot
2c. Co-Sponsor Update Periods
Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator
Pooja Babbrah, Jean Duteau
2e. Other Interested Parties (and roles)
2f. Modeling Facilitator
2g. Publishing Facilitator
Pooja Babrah, Paul Knapp
2h. Vocabulary Facilitator
Tim McNeil
2i. Domain Expert Representative
2j. Business Requirements Analyst
2k. Conformance Facilitator
Pooja Babbrah
2l. Other Facilitators
2m. Implementers
Humana, Cambia
3a. Project Scope
Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
Attachments
3b. Project Need
The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk
No
3d. External Drivers
Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates
A FHIR R4 Implementation Guide
The desired ballot is January 2020.
Rough timeline
8/2019 - Draft implementation guide published
9/2019 - Connectathon
10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group
11/2019 - Ballot material approved by Pharmacy Work Group
1/2020 - Ballot
It's not clear to me that NCPDP is directly involved in this project even though the scope basically says this work will be similar to an NCPDP API. HL7 has an SOU with NCPDP that covers joint work and joint copyrights.
Pharmacy WG has indicated that they would like to be the sponsor of this project given it seems to overlap with the daVinci Formulary Implementation Guide that Pharmacy owns.
Ryan HowellsPooja Babbrah In preparing this for TSC e-vote, I noticed that it is still missing the link to the HL7-managed project document repository in section 3.i. One you've got that entered, I will send it for their review.
10 Comments
Anne Wizauer
Ryan Howells Needs percentage of content externally developed, who developed the content, and cosponsor approval date.
Ryan Howells
Anne Wizauer Complete. Cosponsor approval date forthcoming.
Anne Wizauer
Thank you!
Austin Kreisler
It's not clear to me that NCPDP is directly involved in this project even though the scope basically says this work will be similar to an NCPDP API. HL7 has an SOU with NCPDP that covers joint work and joint copyrights.
Ryan Howells
They are involved and very supportive.
Brett Marquard
Is FM the right home for this project? How does it relate to CDS Hooks which enables real-time checks?
Melva Peters
Pharmacy WG has indicated that they would like to be the sponsor of this project given it seems to overlap with the daVinci Formulary Implementation Guide that Pharmacy owns.
Brett Marquard
Have you presented to Clinical Decision Support Work Group?
Anne Wizauer
Ryan Howells Pooja Babbrah In preparing this for TSC e-vote, I noticed that it is still missing the link to the HL7-managed project document repository in section 3.i. One you've got that entered, I will send it for their review.
Pooja Babbrah
Anne Wizauer - Section 3.i has been updated. Please let me know if you need anything else.