Purpose

This method is designed to create a 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 which it goes to EXPIRED status.

Key features

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. The total of medication_qty should be less or equal to the medication quantity specified in the Medication Request.

Status Charts (reimbursement).

Specification

Logic

1. Get skip_medication_dispense_sign from medical program settings.

2. If skip_medication_dispense_sign = false or absent:

          2.1. Check payment_id, payment_amount is present in the request.

in case if absent - return 422 with path: $.<field_name>  and message "schema does not allow additional properties"

          2.2. Add record to medication_dispenses table:

          2.3. Add records to medication_dispense_details table:

          2.4. Add records to medication_2d_codes table (for each 2d code object in array):

1. If skip_medication_dispense_sign =

true:

             3.1. Check if payment_amount in the request.

• in case is absent - return 422 with path: $.payment_amount and message "required property payment_amount was not present"

             3.1. Call Process Medication Dispense by Pharmacy User process, but without validation of the previously created (NEW) medication dispense, digital sign and storage signed content to the bucket.

             3.2. Add records as described on steps 2.2-2.4, but with following differences: 

             medication_dispenses table

Preconditions

No

Global and configurable parameters

No

Input parameters

No

Filters

Request structure

Example:

Authorize

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).

Headers

Content-Type:application/json

Authorization:Bearer c2778f3064753ea70de870a53795f5c9

Validate request

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Request data validation

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:

2. Validate 

medication_request_id - medication_request_id exists

3. Validate 

party_id - party_id exists

4. Validate 

division_id - division_id exists

5. Validate 

medical_program_id - medical_program_id exists

6. Validate all medication_id (brand_id) - brand_id exists

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").

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. 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

If division_id submitted:

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. 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 409 ('Division must have active licenses to dispense medication request').

Validate Medical Program

Get medical_program_change_on_dispense_allowed parameter from settings of medical program from medication request:

• if it is false (absent), medical program in dispense must be the same as medical program in medication request (request.medical_program_id = medication_requests.medical_program_id)

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

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. Get medical_program_id from request of the medication dispense.

   2. Invoke Qualify method with medical_program_id.

   3. Check that program_medication_id is in Qualify response.

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:

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:

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 

   • is_active = true.

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 Medication request is_blocked flag

• Get Medication request by $.medication_request_id from OPS DB. Check that Medication request is not blocked (is_blocked = false or null)

  • in case of error - return 409 ("Medication request is blocked").

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

• medictaion 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. Get multi_medication_dispense_allowed parameter from medical program settings:

   1. if it is true - check that requested medication quantity less or equal to medication quantity in Medication Request

      1. sum(:medication_qty) <= medication_request.medication_qty

         1. in case of error - return 422 "Dispensed medication quantity must be lower or equal to medication quantity in Medication Request. Available quantity is #{available_qty}".

   2. if it is false (absent) - check that requested medication quantity equal to medication quantity in Medication Request

      1. medication_qty = medication_request.medication_qty

         1. in case of error - return 422 "Dispensed medication quantity must be equal to medication quantity in Medication Request".

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:

Validate medication discount amount

1. Define reimbursement_type (get from program_medications by program_medication_id).

2. Validate percentage discount price.
   Check if reimbursement_type == percentage and percentage_reimbursement_amount = 0
   (the way how to calculate percentage_reimbursement_amount is following:
   percentage_reimbursement_amount = sell_price (from request) * percentage_discount (from program_medications) /100)

   • In case if discount_amount != 0 - return 422 ("Requested discount price must be equal to 0")

   • Else (if discount_amount = 0)  - finish validation (do not validate 3, 4).

3. Validate allowed reimbursement amount.
   Check that requested discount price is less or equal to allowed reimbursement amount for the requested medication quantity
   (the way how to calculate allowed reimbursement amount is below.
   for type == percentage use percentage_reimbursement_amount, for fixed = use reimbusement_amount from program_medications):
          discount_amount <= reimbursement_amount * (medication_qty/package_qty)

   • In case of error - return 422 ("Requested discount price must be less or equal to allowed reimbursement amount").

4. Validate the ratio of discount price to reimbursement amount.
   Check that the ratio of requested discount price to allowed reimbursement amount is more or equal to allowed rule (including deviation) for the requested medication quantity
   (the way how to calculate allowed reimbursement amount is below.
   for type = percentage use percentage_reimbursement_amount, for fixed - use reimbusement_amount from program_medications):
          discount_amount/ (reimbursement_amount * (medication_qty/package_qty)) >= 1 - deviation

   • In case of error - return 422 ("The ratio of requested discount price to allowed reimbursement amount must be greater or equal to <1 - deviation>").

Validate 2d codes

Important: This validation must be done only if medication_2d_codes field exists in request.

• Check that medication_2d_codes array contains at least one element (array is not empty)

  • in case of error - return 422 ('Expected a minimum of %{min} items but got %{actual}').

• For all objects in array check that string 'medication_2d_code' is not null or empty

  • in case of error - return 422 ('Not allowed to save empty 2d code').

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_qt.

Parameters that are used when processing the request

Configuration parameters

Access to the method is defined by the scope medication_dispense:write. Permission for this scope is determined by the System administrator by configuring scopes in the context of clients and roles.

Dictionaries

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Processing

1. Get skip_medication_dispense_sign from medical program settings.

2. If skip_medication_dispense_sign = false or absent:

          2.1. Check payment_id, payment_amount is absent in the request.

• in case if present - return 422 with path: $.<field_name>  and message "schema does not allow additional properties"

          2.2. Add record to medication_dispenses table:

          2.3. Add records to medication_dispense_details table:

          2.4. Add records to medication_2d_codes table (for each 2d code object in array):

1. If skip_medication_dispense_sign = true:

             3.1. Check if payment_amount in the request

• in case is absent - return 422 with path: $.payment_amount and message "required property payment_amount was not present"

             3.2. Call Process Medication Dispense process, but without validation of the previously created (NEW) medication dispense, digital sign and storage signed content to the bucket.

             3.3. Add records as described on steps 2.2-2.4, but with following differences: 

             medication_dispenses table:

Response structure

Example:

Post-processing processes

No

HTTP status codes

Backward compatibility

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