Purpose

This method is designed to create hold (reservation) on medication in order to prevent multiple dispenses under the same Medication Request. This hold lasts certain time (configuration parameter MEDICATION_DISPENSE_EXPIRATION) after with it goes to EXPIRED status

1. Dispense of medication is possible only under Medication Request and during the period specified in Medication Request (dispense_valid_from, dispense_valid_to)

2. Dispense details - several medications of different manufacturers with the same substance can be dispensed at a time. Total of medication_qty should be less or equal to medication quantity specified in Medication Request

3. If patient wants to split medication dispense of his medication request into several parts, it is possible to create and process medication dispense of the medication request with the desired medication quantity.

Status Charts (reimbursement)

Specification

Apiary

WS logic

Authorize user

1. Verify the validity of access token
   

   1. Return 401 in case validation fails

2. Check user scopes in order to perform this action (scope = 'medication_dispense:write')

   1. Return 403 in case invalid scope(s)

Validate request

Schema validation

1. Validate request according to JSON Schema

   • Return 422 with list of validation errors in case validation fails (422 EView)

Validate program medication

In case medications are dispensed to patient under specific medical program, program medication id must be provided provided by client or calculated by the system

In case program medication id exists in request:

1. Check that this program medication id relates to provided medical program and relates to provided medication
   

   1. In case of error - return 422 (Invalid program medication id)

Calculate program medication id if it is absent in request:

1. Get last program_medication_id related to medical program and medication

   1. In case of error - return 422 (There are no active program medications for this program and medication)

Get legal entity from token

1. Extract legal_entity_id (client_id) from token

Get Party from token

1. Extract party_user (user_id) from token.

Validate FK

1. Validate legal_entity_id - legal_entity_id exists

In case error - return 422 error:

{:error, [{%{
        description: "Legal entity not found",
        params: [],
        rule: :invalid
      }, "$.legal_entity_id"}]}

2. Validate medication_request_id - medication_request_id exists

{:error, [{%{
        description: "Medication request not found",
        params: [],
        rule: :invalid
      }, "$.medication_request_id"}]}

3. Validate party_id - party_id exists

{:error, [{%{
        description: "Party not found",
        params: [],
        rule: :invalid
      }, "$.party_id"}]}

4. Validate division_id - division_id exists

{:error, [{%{
        description: "Division not found",
        params: [],
        rule: :invalid
      }, "$.division_id"}]}

5. Validate medical_program_id - medical_program_id exists

{:error, [{%{
        description: "Medical program not found",
        params: [],
        rule: :invalid
      }, "$.medical_program_id"}]}

5.1 Validate there is a contract in PRM.contracts that meets following requirements:

1. contracts.type==reimbursement

2. contracts.status==VERIFIED

3. Contract dates: start_date <= current_date & end_date >= current_date

4. contracts.contractor_legal_entity_id=token.client_id

5. $division_id in contract_divisions

6. contracts.medical_program_id==$.medical_program_id

7. сontracts.is_suspended ==false

In  case of error 409 - "Program cannot be used - no active contract exists"

Validate all medication_id (brand_id) - brand_id exists

{:error, [{%{
        description: "Medication not found",
        params: [],
        rule: :invalid
      }, "$.dispense_details[:index].medication_id"}]}

Validate related Care plan

If (medication_request.based_on is present and not null) AND medication_program is absent:

1. Verify Care plan:

   1. It should be in active status

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

2. Verify care plan Activity:

   1. It has scheduled, in_progress status

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

Validate code

1. Check that code in request is equal to code in medication_request (or both is empty)

   1. In case code exists in request - it should match with code in medication_request

      1. Return 401 in case code doesn't match (message = "Incorrect code")

   2. In case code is missing in request - check that code in medication_request is NULL

      1. Return 401 in case code in medication_request is not NULL (message = "Missing or Invalid code")

Qualify medication request

Important: This validation must be done only if medical_program exists in request

1. Check that medication request is valid and available for dispense

   1. Invoke Qualify method

   2. Use medication_requests.medical_program_id as program for qualify

   3. Check that program_medication_id is in Qualify response

Dispense prohibited

Medication request is prohibited for dispense in case $.data[?(@.program_id=medication_requests.medical_program_id)].status = 'INVALID' or program_medication_id is absent in qualify response

{
    "meta": {
        "url": "http://dev.ehealth.world/api/medication_requests/ed56699a-4a6d-427c-9b93-33a4a8d0b7b0/actions/qualify",
        "type": "list",
        "request_id": "unrbcrs34t0cinqpe8fb6nu7oem17qim",
        "code": 200
    },
    "data": [
        {
            "status": "INVALID",
            "rejection_reason": "For the patient at the same term there can be only 1 dispensed medication request per one and the same innm!",
            "program_name": "Доступні ліки",
            "program_id": "3c7d7a7f-82c2-4f5c-806e-f1f5b55164a2",
            "participants": []
        }
    ]
}

In case of error - return 409 error (message = "Medication request can not be dispensed. Invoke qualify medication request API to get detailed info")

Dispense is allowed

Medication request is allowed for dispense in case $.data[?(@.program_id=medication_requests.medical_program_id)].status = 'VALID' and program_medication_id is present in qualify response

{
    "meta": {
        "url": "http://dev.ehealth.world/api/medication_requests/ed56699a-4a6d-427c-9b93-33a4a8d0b7b0/actions/qualify",
        "type": "list",
        "request_id": "unrbcrs34t0cinqpe8fb6nu7oem17qim",
        "code": 200
    },
    "data": [
        {
            "status": "VALID",
            "program_name": "Доступні ліки",
            "program_id": "3c7d7a7f-82c2-4f5c-806e-f1f5b55164a2",
            "participants": []
        }
    ]
}

Validate statuses

1. Legal entity should be active in order to dispense medication

   • is_active = true

   • status = 'ACTIVE'

   • type in pharmacy_allowed_transactions_le_types

   • mis_verified = `VERIFIED`

2. Medication request should be active in order to dispense medication

   • is_active = true

   • status = 'ACTIVE'

   • started_at <= current_date() and ended_at >= current_date()

3. Party should refer to active employee in current legal_entity
   

   • employees.is_active = true

   • employees.status = 'APPROVED'

   • employees.legal_entity_id = client_id (context)

4. Division should be active and refers to current legal_entity

   • is_active = true

   • status = 'ACTIVE'

   • divisions.legal_entity_id = client_id (context)

5. Medical Program should be active in order to dispense medication under this program and the same as medical program in medication request

   • is_active = true

   • If medication_requests.medical_program_id was set, then check request.medical_program_id = medication_requests.medical_program_id

     • in case of error return 409 Error (`Medical program in dispense doesn't match the one in medication request`)

6. Medication (brand) medication should be active

   1. medications.is_active = true

   2. medications.type = 'BRAND'

   3. ingredients.medication_child_id = medication_request.medication_id and ingredients.is_primary = true

   4. medication_id exists in program_medications (is_active = true)

Validate division license

Division must have active pharmacy license in order to dispense medications

1. Check division parameters

   1. division.dls_verified must be true

      1. otherwise - return 409 error ('Invalid division dls status')

Validate dispense period

1. Check that dispense date is in period specified in Medication Request

   • dispense_valid_from <= current_date()

   • dispense_valid_to >= current_date()

Check other Medication Dispenses

1. Check all connected medication dispenses

• sum of medication_qty of all connected medication dispenses <= medication_request.medication_qty

• medication dispenses status in ('NEW', 'PROCESSED')

In case of error - return 403 error (message = "No more medication dispense could be done with this medication request")

Validate medication quantity

1. Check that requested medication quantity less or equal to medication quantity in Medication Request

   • sum(:medication_qty) <= medication_request.medication_qty

Validate medication multiplicity

1. Check that requested medication quantity in dispense for all medications is multiplier of package_min_qty for this medications.id

   •  Mod($medication_qty, medications.package_min_qty) = 0

In case of error (if at least one of medication don't pass verification) - return 422 error

{:error, [{%{
        description: "Requested medication brand quantity is not a multiplier of package minimal quantity",
        params: [],
        rule: :invalid
      }, "$.dispense_details[:index].medication_qty"}]}

Validate medication discount amount

Note: There are two different validation rules depending on medication package quantity and min quantity

If min quantity is equal to package quantity - there shouldn't be any tolerance during calculation. 

Validation 1: Min package quantity is equal to package quantity

1. Check that requested discount price is equal to allowed reimbursement amount for the requested medication quantity (the way how to calculate allowed reimbursement amount is below)

• discount_amount = reimbursement_amount * (medication_qty/package_qty)

Validation 2: Min package quantity is not equal to package quantity

1. Check that requested discount price less or equal to allowed reimbursement amount (including deviation) for the requested medication quantity (the way how to calculate allowed reimbursement amount is below)

• 1 > = discount_amount/ (((reimbursement_amount/package_qty)*medication_qty)) >= 1 - deviation

In case of error - return 422 error

{:error, [{%{
        description: "Requested discount price doesn't not satisfy allowed reimbursement amount",
        params: [],
        rule: :invalid
      }, "$.dispense_details[:index].discount_amount"}]}

Medication dispense in a multi attempts

Validate medication multiplicity

1. Check that requested medication quantity in dispense for all medications is multiplier of package_min_qty for this medications.id

   •  Mod($medication_qty, medications.package_min_qty) = 0

In case of error - return 422 error

{:error, [{%{
        description: "Requested medication brand quantity is not a multiplier of package minimal quantity",
        params: [],
        rule: :invalid
      }, "$.dispense_details[:index].medication_qty"}]}

Note: The medication_qty with each attempt can be divided only by an integer.

Validate medication quantity

1. Check that medication_qty on medication dispense should not exceed the sum of medication_qty already dispensed under this medication request.
   

   • Find existing medication dispenses by its medication_request_id

   • Count the amount of medication_qty dispensed for this medication request
     

     1. $.medication_dispense.medication_request_id = $.medication_request.id

     2. $.medication_dispense.status = PROCESSED

     3. $.medication_dispense.medication_qty <= sum_{previously processed}(medication_dispense_details.medication_qty)

In case of error - return 422 error

{:error, [{%{
        description: "Sum of dispense's medication quantity can not be more then medication_request.medication_qty",
        params: [],
        rule: :invalid
      }, "$.dispense_details[:index].medication_qty"}]}

Get reimbursement amount

There are two types of calculation of reimbursement amount:

• FIXED - reimbursement rate defined here for package_qty without any calculations 

• EXTERNAL - reimbursement rate or amount should be calculated via API external call

Important: Only FIXED type is allowed during first phase

1. Get reimbursement amount for this medication_id according to medical_program_id

   1. Determine calculation channel (FIXED, EXTERNAL)

   2. Calculate reimbursement amount for the requested quantity of medications:

      1. Get the reimbursement_amount from program_medications.reimbursement.reimbursement_amount (for the package)

      2. Based on it,  package_min_qty and requested medication_qty calculate the ratio and allowed reimbursement amount ((reimbursement_amount/package_qty)*medication_qty)

Create new entities

Add record to medication_dispenses

Add records to medication_dispense_details