Module: Formulary

Defined in:
lib/formulary.rb,
lib/formulary/config.rb,
lib/formulary/qhp_drug.rb,
lib/formulary/qhp_plan.rb,
lib/formulary/qhp_importer.rb,
lib/formulary/qhp_drug_repo.rb,
lib/formulary/qhp_drug_tier.rb,
lib/formulary/qhp_plan_drug.rb,
lib/formulary/qhp_plan_repo.rb,
lib/formulary/formulary_factory.rb,
lib/formulary/drug_list_generator.rb,
lib/formulary/formulary_drug_factory.rb,
lib/formulary/formulary_item_factory.rb,
lib/formulary/qhp_drug_tier_cost_sharing.rb,
lib/formulary/payer_insurance_plan_factory.rb,
lib/formulary/quantity_limit_detail_extension_factory.rb

Overview

Build conformant FHIR resources for the DaVinci PDex US Drug Formulary

Defined Under Namespace

Classes: Config, DrugListGenerator, FormularyDrugFactory, FormularyFactory, FormularyItemFactory, PayerInsurancePlanFactory, QHPDrug, QHPDrugRepo, QHPDrugTier, QHPDrugTierCostSharing, QHPImporter, QHPPlan, QHPPlanDrug, QHPPlanRepo, QuantityLimitDetailExtensionFactory

Constant Summary collapse

PAYER_INSURANCE_PLAN_PROFILE =

Payer Insurance Plan profile's official URL

"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan"
FORMULARY_PROFILE =

Formulary profile's official URL

"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Formulary"
FORMULARY_ITEM_PROFILE =

Formulary Item profile's official URL

"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyItem"
FORMULARY_DRUG_PROFILE =

Formulary Drug profile's official URL

"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"
DRUG_TIER_SYSTEM =

Drug Tier CodeSystem

"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"
RXNORM_SYSTEM =

rxnorm CodeSystem

"http://www.nlm.nih.gov/research/umls/rxnorm"
PHARMACY_TYPE_SYSTEM =

Pharmacy Benefit Type CodeSystem

"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS"
COST_SHARE_SYSTEM =

Cost share option CodeSystem

"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS"
FORMULARY_ITEM_SYSTEM =

Formulart Item CodeSystem

"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS"
INSURANCE_PRODUCT_TYPE_SYSTEM =

Insurance product type CodeSystem

"http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS"
FORMULARY_TYPE_SYSTEM =

Formulary type CodeSystem

"http://terminology.hl7.org/CodeSystem/v3-ActCode"
CONTACT_ENTITY_SYSTEM =

Contact entity type CodeSystem

"http://terminology.hl7.org/CodeSystem/contactentity-type"
PLAN_CONTACT_TYPE_CS = 
"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS"
PLAN_TYPE_SYSTEM =

Insurance plan type CodeSystem

"http://terminology.hl7.org/CodeSystem/insurance-plan-type"
BENEFIT_COST_TYPE_SYSTEM =

Benefit cost type CodeSystem

"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS"
UCUM_SYSTEM =

Unit form CodeSystem

"http://unitsofmeasure.org"
"http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-RelatedMedicationTypeCS"
FORMULARY_REFERENCE_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension"
AVAILABILITY_STATUS_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension"
AVAILABILITY_PERIOD_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension"
PHARMACY_TYPE_EXTENSION =

Pharmacy benefit type extension

"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension"
DRUG_TIER_ID_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension"
PRIOR_AUTH_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension"
PRIOR_AUTH_NEW_START_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension"
STEP_THERAPY_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension"
STEP_THERAPY_NEW_START_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension"
QUANTITY_LIMIT_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension"
QUANTITY_LIMIT_DETAIL_EXTENSION = 
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimitDetail-extension"
QUANTITY_LIMIT_DETAIL_ROLLING_EXTENSION = 
"Rolling"
QUANTITY_LIMIT_DETAIL_MAXIMUM_DAILY_EXTENSION = 
"MaximumDaily"
QUANTITY_LIMIT_DETAIL_DAYS_SUPPLY_EXTENSION = 
"DaysSupply"
PAYER_PLAN_ID_PREFIX = 
"PayerPlan-"
FORMULARY_ID_PREFIX = 
"Formulary-"
FORMULARY_ITEM_ID_PREFIX = 
"FormularyItem-"
DRUG_ID_PREFIX = 
"Drug-"
FORMULARY_TYPE_CS_CODE =

Formulary type CodeSystem code

"DRUGPOL"
FORMULARY_TYPE_CS_DISPLAY =

Formulary type CodeSystem display

"drug policy"
CONTACT_PATINF_CODE = 
"PATINF"
CONTACT_PATINF_DISPLAY = 
"Patient"
CONTACT_MARKETING_CODE = 
"MARKETING"
CONTACT_MARKETING_DISPLAY = 
"Plan Marketing Information"
CONTACT_SUMMARY_CODE = 
"SUMMARY"
CONTACT_SUMMARY_DISPLAY = 
"Plan Summary Information"
CONTACT_FORMULARY_CODE = 
"FORMULARY"
CONTACT_FORMULARY_DISPLAY = 
"Plan Formulary Information"
PLAN_TYPE_CODE = 
"drug"
PLAN_TYPE_DISPLAY = 
"Drug"
COPAY_AMOUNT_CODE =

Copay amount unit

"USD"
COPAY_AMOUNT_SYSTEM =

Copay amount unit CodeSystem

"urn:iso:std:iso:4217"
PHARMACY_TYPE_DISPLAY =

Pharmacy type CS code => display values

{
  "1-month-in-retail" => "1 month in network retail",
  "1-month-out-retail" => "1 month out of network retail",
  "1-month-in-mail" => "1 month in network mail order",
  "1-month-out-mail" => "1 month out of network mail order",
  "3-month-in-retail" => "3 month in network retail",
  "3-month-out-retail" => "3 month out of network retail",
  "3-month-in-mail" => "3 month in network mail order",
  "3-month-out-mail" => "3 month out of network mail order",
}.freeze
DRUG_TIER_DISPLAY =

Drug tier CS code => display values

{
  "generic" => "Generic",
  "preferred-generic" => "Preferred Generic",
  "non-preferred-generic" => "Non-preferred Generic",
  "specialty" => "Specialty",
  "brand" => "Brand",
  "preferred-brand" => "Preferred Brand",
  "non-preferred-brand" => "Non-preferred Brand",
  "zero-cost-share-preventative" => "Zero cost-share preventative",
  "medical-service" => "Medical Service",
}.freeze
COST_SHARE_OPTION_DISPLAY =

Codes qualifying the type of cost share amount (code => display)

{
  "after-deductible" => "After Deductible",
  "before-deductible" => "Before Deductible",
  "no-charge" => "No Charge",
  "no-charge-after-deductible" => "No Charge After Deductible",
  "charge" => "Charge",
  "coinsurance-not-applicable" => "	Coinsurance Not Applicable",
  "copay-not-applicable" => "	Copay Not Applicable",
  "deductible-waived" => "Deductible Waived",
}.freeze