Extensions

Several extensions are needed to capture the metadata about formularies and the medications that they list.

TODO: All of these extensions are using http://example.org/fhir as their baseurl, which is not real. Find an authoritative location to store these extensions.

For each formulary:

• Formulary-EffectiveFrom
• Formulary-EffectiveTo
• Formulary-PlanYear
  • TODO: this is currently an integer. Should it be a string for the plans that span multiple years (e.g., 2007-2008)?
• Formulary-HealthPlan
  • TODO: this is currently a string. Should it be a reference instead?
  • TODO: should the reference be on the other side - plans reference the formularies that they include?
• TODO: Formulary ID, for handling associations between Health Plans and their respective formularies
  • Do plans ever have multiple formularies associated with them, or is it just a 1:1 relationship?
• TODO: Number of Drug Tiers as an integer (3, 4, 5, 6, others?)
• TODO: Co-payment/co-insurance amounts associated with each tier

For each medication:

• TODO: Drug Tier as an integer
• TODO: Drug Classification Code
  • This could be a WHO ATC code or a First Data Bank code?
  • This may also be a string, if no code system is widely used/available
• Formulary-CoPayRequired
  • TODO: Is this necessary if the drug tier dictates the copay amount?
• Formulary-CoInsuranceRequired
  • TODO: Is this necessary if the drug tier dictates the co-insurance amount?
• Formulary-PriorAuthRequired
• Formulary-PriorAuthDescription
• Formulary-StepTherapyRequired
• Formulary-StepTherapyDescription
• Formulary-QuantityLimitImposed
• Formulary-QuantityLimitDescription
• Formulary-AgeLimitImposed
• Formulary-AgeLimitDescription
• Formulary-LimitedAccessImposed
• Formulary-LimitedAccessDescription
• Formulary-Injectable
• Formulary-MailOrder
• Formulary-PartBOrPartD