DaVinci Payer Data Exchange (PDex) US Drug Formulary
1.1.0 - STU 1.1

This page is part of the US Drug Formulary (v1.1.0: STU 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: Formulary Coverage Plan

Defining URL:http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan
Version:1.1.0
Name:CoveragePlan
Title:Formulary Coverage Plan
Status:Active as of 2021-10-15T15:46:55+00:00
Definition:

A health plan which contains links to administrative information, a list of formulary drugs covered under that plan, and a definition of drug tiers and their associated cost-sharing models.

Publisher:HL7 Pharmacy Working Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan

Note: Future versions of this Implementation Guide may base the CoveragePlan profile on the InsurancePlan resource instead of the List resource.

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from List

NameFlagsCard.TypeDescription & Constraintsdoco
.. List 0..*ListA list is a curated collection of resources
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-DrugTierDefinition-extension S1..*(Complex)Drug Tier Definition
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
... usdf-Network-extension S1..*stringNetwork
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
... usdf-FormularyURL-extension S0..1urlFormulary URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
... usdf-EmailPlanContact-extension S0..1urlEmail Plan Contact
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
... usdf-MarketingURL-extension S0..1urlMarketing URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
... usdf-PlanIDType-extension S1..1stringPlan ID Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
... code 1..1CodeableConceptWhat the purpose of this list is
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. List I0..*ListA list is a curated collection of resources
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-DrugTierDefinition-extension S1..*(Complex)Drug Tier Definition
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
... usdf-Network-extension S1..*stringNetwork
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
... usdf-SummaryURL-extension S1..1urlSummary URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
... usdf-FormularyURL-extension S0..1urlFormulary URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
... usdf-EmailPlanContact-extension S0..1urlEmail Plan Contact
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
... usdf-MarketingURL-extension S0..1urlMarketing URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
... usdf-PlanIDType-extension S1..1stringPlan ID Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness identifier
... status ?!Σ1..1codecurrent | retired | entered-in-error
Binding: ListStatus (required): The current state of the list.

... mode ?!Σ1..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this list.

... title Σ0..1stringDescriptive name for the list
Example General: Dr. Jane's Patients
... code Σ1..1CodeableConceptWhat the purpose of this list is
Binding: ExampleUseCodesForList (example): What the purpose of a list is.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject Σ0..1Reference(Patient | Group | Device | Location)If all resources have the same subject
... encounter 0..1Reference(Encounter)Context in which list created
... date Σ0..1dateTimeWhen the list was prepared
... source Σ0..1Reference(Practitioner | PractitionerRole | Patient | Device)Who and/or what defined the list contents (aka Author)
... orderedBy 0..1CodeableConceptWhat order the list has
Binding: ListOrderCodes (preferred): What order applies to the items in a list.

... note 0..*AnnotationComments about the list
... entry I0..*BackboneElementEntries in the list
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... flag 0..1CodeableConceptStatus/Workflow information about this item
Binding: PatientMedicineChangeTypes (example): Codes that provide further information about the reason and meaning of the item in the list.

.... deleted ?!I0..1booleanIf this item is actually marked as deleted
.... date 0..1dateTimeWhen item added to list
.... item 1..1Reference(Resource)Actual entry
... emptyReason I0..1CodeableConceptWhy list is empty
Binding: ListEmptyReasons (preferred): If a list is empty, why it is empty.


doco Documentation for this format

Differential View

This structure is derived from List

NameFlagsCard.TypeDescription & Constraintsdoco
.. List 0..*ListA list is a curated collection of resources
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-DrugTierDefinition-extension S1..*(Complex)Drug Tier Definition
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
... usdf-Network-extension S1..*stringNetwork
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
... usdf-FormularyURL-extension S0..1urlFormulary URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
... usdf-EmailPlanContact-extension S0..1urlEmail Plan Contact
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
... usdf-MarketingURL-extension S0..1urlMarketing URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
... usdf-PlanIDType-extension S1..1stringPlan ID Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
... code 1..1CodeableConceptWhat the purpose of this list is
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. List I0..*ListA list is a curated collection of resources
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-DrugTierDefinition-extension S1..*(Complex)Drug Tier Definition
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
... usdf-Network-extension S1..*stringNetwork
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
... usdf-SummaryURL-extension S1..1urlSummary URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
... usdf-FormularyURL-extension S0..1urlFormulary URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
... usdf-EmailPlanContact-extension S0..1urlEmail Plan Contact
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
... usdf-MarketingURL-extension S0..1urlMarketing URL
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
... usdf-PlanIDType-extension S1..1stringPlan ID Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness identifier
... status ?!Σ1..1codecurrent | retired | entered-in-error
Binding: ListStatus (required): The current state of the list.

... mode ?!Σ1..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this list.

... title Σ0..1stringDescriptive name for the list
Example General: Dr. Jane's Patients
... code Σ1..1CodeableConceptWhat the purpose of this list is
Binding: ExampleUseCodesForList (example): What the purpose of a list is.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: DRUGPOL
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject Σ0..1Reference(Patient | Group | Device | Location)If all resources have the same subject
... encounter 0..1Reference(Encounter)Context in which list created
... date Σ0..1dateTimeWhen the list was prepared
... source Σ0..1Reference(Practitioner | PractitionerRole | Patient | Device)Who and/or what defined the list contents (aka Author)
... orderedBy 0..1CodeableConceptWhat order the list has
Binding: ListOrderCodes (preferred): What order applies to the items in a list.

... note 0..*AnnotationComments about the list
... entry I0..*BackboneElementEntries in the list
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... flag 0..1CodeableConceptStatus/Workflow information about this item
Binding: PatientMedicineChangeTypes (example): Codes that provide further information about the reason and meaning of the item in the list.

.... deleted ?!I0..1booleanIf this item is actually marked as deleted
.... date 0..1dateTimeWhen item added to list
.... item 1..1Reference(Resource)Actual entry
... emptyReason I0..1CodeableConceptWhy list is empty
Binding: ListEmptyReasons (preferred): If a list is empty, why it is empty.


doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
List.languagepreferredCommonLanguages
Max Binding: AllLanguages
List.statusrequiredListStatus
List.moderequiredListMode
List.codeexamplePattern: DRUGPOL
List.orderedBypreferredListOrderCodes
List.entry.flagexamplePatientMedicineChangeTypes
List.emptyReasonpreferredListEmptyReasons