Da Vinci Project PDex Drug Formularies Track December

Da Vinci Project PDex Drug Formularies Track December Da Vinci Connectathon December 11 -12, 2019

Agenda • What is a Drug Formulary • Goals for this Connectathon • Tracking Issues • Resources • Use Cases • Reference Implementation Demonstration

What is A Drug Formulary? • 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. • Within a formulary: • Each drug is associated with a drug tier and specific prescription restrictions • Each drug tiers is associated with plan-level copay and coinsurance costs • The PDEX Drug Formulary data content is largely based on: • the formularies for Qualified Health Plans (QHPs) on the federal health insurance marketplace for healthcare. gov

Goals for Connectathon • Feedback on Implementation Guide • Feedback on Reference Implementation • Testing the API and interfacing with other software • Validating the Use Cases

Tracking Issues • Reference Implementation Integration Issues • Zulip - https: //chat. fhir. org/#narrow/stream/207606 -Da. Vinci. 2 Fplan-net-connectathon • Implementation Guide Issues: • Jira - https: //jira. hl 7. org

Resources • Track Proposal • https: //wiki. hl 7. org/index. php? title=Da_Vinci_PDex-formulary_FHIR_IG_Proposal • Implementation Guide • http: //build. fhir. org/ig/HL 7/davinci-pdex-formulary/ • Reference Implementation Code • Server: • Generated Data Collection: • Client: • Hosted Reference Implementation • Server: • Client: https: //github. com/HL 7 -Da. Vinci/drug-formulary-ri <Not yet released> https: //github. com/HL 7 -Da. Vinci/pdex-formulary-client https: //davinci-drug-formulary-ri. logicahealth. org/fhir https: //davinci-pdex-formulary-client. logicahealth. org

Use Cases • Scenario : 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 plan-level cost information. Bonus point: None • Scenario : Shopping for Health Plans • Action: Query content of multiple drug formularies for a list of medications • Precondition: Determine list of medication for the patient • Success Criteria: Compare plan-level costs for medication list for multiple insurance plans • Bonus point: None

Reference Implementation Demonstration