Purpose

This WS is designed to qualify Medication request (post) - check the ability to use Medication request within the Medication program and receive program participants

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Технічний опис бізнес-процесу погашення рецепту в ЦБД ЕСОЗ

Preconditions

No

Global and configurable parameters

No

MR should be found by number

Input parameters

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No

Request structure

See on Apiary

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1. Verify Care plan:

   1. It should be in active status

      1. in case of error - return 409 (message: "Invalid care plan status").

   2. Care plan's period end (if exist) should be greater than current date or equal

      1. in case of error - return 409 (message: “Care plan expired“).

2. Verify care plan Activity:

   1. It has scheduled, in_progress status

      1. in case of error - return 409 (message: "Invalid activity status").

Validate division

1. Validate division is active

   1. in case of error - return 409 ("Division is not active")

2. Validate division belongs to user's legal entity

   1. in case of error - return 409 ("Division does not belong to user's legal entity")

3. If chart parameter DISPENSE_DIVISION_DLS_VERIFY is on, then validate division is DLS verified (dls_verified=true)

   1. in case of error - return 409 "Division is not verified in DLS"

4. Check division participates in submitted programs. Validate Provision for each Medical Program:

   1. If the medical program has no setting skip_contract_provision_verify or it is equal to false/null:

      1. if medical program in the request has funding_source one of NHS, LOCAL

         1. In case of error - return status=INVALID for a program, rejection_reason="Program was configured incorrectly. Either incorrect source of funding or option skip_contract_provision_verify"

      2. provision exist and active for the division:

         1. in case of error - return status=INVALID for a program, rejection_reason= "Division does not provide the medical program"

      3. if medical program in the request has funding_source = NHS:

         1. provision relates to the actual reimbursement contract: contract.start_date <= current_date <= contract.end_date, is_active = true, status = VERIFIED, contracts.type==reimbursement, contracts.contractor_legal_entity_id=token.client_id, contracts.medical_program_id==$.medical_program_id

            1. in case of error - return status=INVALID for a program, rejection_reason="Medical program provision is not related to any actual contract for the current date"

         2. contract is_suspended = false

            1. in case of error - return status=INVALID for a program, rejection_reason="Contract with number <contract_number> is suspended"

      4. if medical program in the request has funding_source = LOCAL, then check medical_program_provision.msp_legal_entity_id = medication_request.legal_entity_id

         1. in case of error - return status=INVALID for a program, rejection_reson = "Medical program can not be provided for the legal entity specified in the medication request"

   2. else if skip_contract_provision_verify = true, then skip provision verification for the medical program

5. Get license_types_allowed parameter from settings of medical program from request $.medical_program_id:

   1. if it is exists and not empty, get list of all license types from parameter.
      Check that division has active healthcare services with following parameters:

      1. legal_entity_id = client_id from access token

      2. division_id = division_id from request

      3. status = 'ACTIVE'

      4. licensed_healthcare_service.status = 'ACTIVE'

      5. healthcare_service.license_id is not null and licenses.type = value from license_types_allowed parameter

         1. in case of error - return status=INVALID for a program, rejection_reason = 'Division does not have active licenses to provide the medical program'

Logic for qualify (analyze compliance with programs)

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• Each Medical program may have its unique conditions for the medication dispense. It can be based on analysis of personal info, medications list, terms, locations and combinations of them.

• For now there are only conditions for the following programs "Dostupni liky", "Netsukrovyy diabet", "Insuliny z doplatoyu", "Insuliny bezoplatno" and we check them.

• Also, it is possible to have the medication dispense without any Medical program.

• However for any Medical program we need a separate block of branching logic.

• Check compatibility only for programs which are available in payload (array)

• If program status is invalid, the reason must be saved and returned in response

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Check INNM_dosage compliance for the programs

Applies to the following programs:

1. Dostupni liky

2. Netsukrovyy diabet

3. Insuliny z doplatoyu

4. Insuliny bezoplatno

Validation purpose:  There is a list of medications (which links to innm_dosage) which can be used for the program. It must be check whether there is at least one available medication for the innm_dosage for the particular program.

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Check absence a same medication for the programs

Applies to the following programs:

1. Dostupni liky

2. Netsukrovyy diabet

3. Insuliny z doplatoyu

4. Insuliny bezoplatno

Validation purpose: It could be done several dispenses for one medication request per one innm for one patient until sum(medication_dispenses.medication_qty) < medication_request.medication_qty

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• MEDICATION_FORM

• COUNTRY

• MEDICATION_UNIT

Processing

API paragraph not found

Response structure

Generate structure for response

• Collect response array for all programs in payload with status for each (VALID or INVALID) and rejection_reason

• For all VALID programs - Get linked medications (type = BRAND) with reimbursement info 

• Show only active program medications based on start_date and end (start_date must be earlier or equal to current date or empty, end_date must be greater or equal to current date or empty)

  • Filter participants simultaneously by container_dosage and max_request_dosage

SELECT *
FROM program_medications pm
    INNER JOIN ingredients i ON (i.parent_id = pm.medication_id
                                 AND i.medication_child_id = :medication_request_medication_id
                                 AND i.is_primary = TRUE)
    INNER JOIN medications m ON (m.id = pm.medication_id)
WHERE pm.medical_program_id = $.id
      AND pm.is_active = TRUE
      AND m.is_active = TRUE
      AND (pm.start_date <= now() OR pm.start_date IS NULL)
      AND (pm.end_date >= now() OR pm.end_date IS NULL)
 
-- added 2022-05-20:
      AND (
      ((M.container ->> 'numerator_unit' = $mr.container_dosage.code) AND
      (M.container ->> 'numerator_value' <>  $mr.container_dosage.value)) OR
           ( ($mr.dosage_container.code is NULL) AND ($mr.container_dosage.value is NULL) )
        )
      AND (M.max_request_dosage >= $.medication_qty or M.max_request_dosage is null)

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{
  "meta": {
    "code": 200,
    "url": "https://example.com/resource",
    "type": "object",
    "request_id": "req-adasdoijasdojsda"
  },
  "data": [
    {
      "program_id": "59781de0-2e64-4359-b716-bcc05a32c10f",
      "program_name": "Програма \"Доступні ліки\"",
      "status": "INVALID",
      "rejection_reason": "Innm not on the list of approved innms for program 'DOSTUPNI LIKI' !",
      "participants": [
        {
          "id": "0f2fbf93-3041-4c0d-a3cf-ff558c861df8",
          "medication_id": "59781de0-2e64-4359-b716-bcc05a32c10f",
          "medication_name": "Амлодипін-КВ",
          "form": "PILL",
          "manufacturer": {
            "name": "ПАТ \"Київський вітамінний завод\"",
            "country": "UA"
          },
          "reimbursement_amount": 15,
          "wholesale_price": 25.14,
          "consumer_price": 34.03,
          "reimbursement_daily_dosage": 1.4438,
          "estimated_payment_amount": 5.15,
          "container_dosage": {
            "numerator_unit": "PILL",
            "numerator_value": 1,
            "denumerator_unit": "PILL",
            "denumerator_value": 1
          },
          "package_min_qty": 20,
          "package_qty": 20,
          "start_date": "2019-01-01",
          "end_date": "2019-06-30",
          "registry_number": "REG-1111"
        }
      ]
    }
  ]
}

Post-processing processes

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HTTP status codes

Backward compatibility

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