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

Extension: Drug Tier Definition

A description of the drug tiers used by the formulary and how those tiers implement copay and coinsurance amounts. Drug tiers do not have any inherent meaning that is consistent across all formularies. Rather, each tier is defined using this element.

The official URL for this extension is: 

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

Status: active
Extension maintained by: HL7 Pharmacy Working Group

Context of Use

This extension may be used on the following element(s):

  • Element

Usage info

Usage:

Formal Views of Extension Content

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

This structure is derived from Extension

Summary

Mandatory: 4 elements (10 nested mandatory elements)
Fixed Value: 9 elements
Prohibited: 9 elements

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionDrug Tier Definition
... extension 2..*ExtensionExtension
... extension:drugTierID 1..1ExtensionDrug Tier ID
.... extension 0..0
.... url 1..1uri"drugTierID"
.... value[x] 1..1CodeableConceptValue of extension
Binding: Drug tier of medication in health plan (extensible)
... extension:mailOrder 1..1ExtensionMail Order
.... extension 0..0
.... url 1..1uri"mailOrder"
.... value[x] 1..1booleanValue of extension
.... extension 5..*ExtensionExtension
.... extension:pharmacyType 1..1ExtensionPharmacy Type
..... extension 0..0
..... url 1..1uri"pharmacyType"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Type of pharmacies (extensible)
.... extension:copayAmount 1..1ExtensionCopay Amount
..... extension 0..0
..... url 1..1uri"copayAmount"
..... value[x] 1..1MoneyValue of extension
.... extension:copayOption 1..1ExtensionCopay Options
..... extension 0..0
..... url 1..1uri"copayOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier of copay amount (required)
.... extension:coinsuranceRate 1..1ExtensionCo-Insurance Rate
..... extension 0..0
..... url 1..1uri"coinsuranceRate"
..... value[x] 1..1decimalValue of extension
.... extension:coinsuranceOption 1..1ExtensionCo-Insurance Option
..... extension 0..0
..... url 1..1uri"coinsuranceOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier for coinsurance rate (required)
.... url 1..1uri"costSharing"
.... value[x] 0..0
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionDrug Tier Definition
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:drugTierID 1..1ExtensionDrug Tier ID
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..0
.... url 1..1uri"drugTierID"
.... value[x] 1..1CodeableConceptValue of extension
Binding: Drug tier of medication in health plan (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..0
.... url 1..1uri"mailOrder"
.... value[x] 1..1booleanValue of extension
... extension:costSharing 0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 5..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension:pharmacyType 1..1ExtensionPharmacy Type
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"pharmacyType"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Type of pharmacies (extensible)
.... extension:copayAmount 1..1ExtensionCopay Amount
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"copayAmount"
..... value[x] 1..1MoneyValue of extension
.... extension:copayOption 1..1ExtensionCopay Options
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"copayOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier of copay amount (required)
.... extension:coinsuranceRate 1..1ExtensionCo-Insurance Rate
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"coinsuranceRate"
..... value[x] 1..1decimalValue of extension
.... extension:coinsuranceOption 1..1ExtensionCo-Insurance Option
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"coinsuranceOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier for coinsurance rate (required)
.... url 1..1uri"costSharing"
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"

doco Documentation for this format

This structure is derived from Extension

Summary

Mandatory: 4 elements (10 nested mandatory elements)
Fixed Value: 9 elements
Prohibited: 9 elements

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionDrug Tier Definition
... extension 2..*ExtensionExtension
... extension:drugTierID 1..1ExtensionDrug Tier ID
.... extension 0..0
.... url 1..1uri"drugTierID"
.... value[x] 1..1CodeableConceptValue of extension
Binding: Drug tier of medication in health plan (extensible)
... extension:mailOrder 1..1ExtensionMail Order
.... extension 0..0
.... url 1..1uri"mailOrder"
.... value[x] 1..1booleanValue of extension
.... extension 5..*ExtensionExtension
.... extension:pharmacyType 1..1ExtensionPharmacy Type
..... extension 0..0
..... url 1..1uri"pharmacyType"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Type of pharmacies (extensible)
.... extension:copayAmount 1..1ExtensionCopay Amount
..... extension 0..0
..... url 1..1uri"copayAmount"
..... value[x] 1..1MoneyValue of extension
.... extension:copayOption 1..1ExtensionCopay Options
..... extension 0..0
..... url 1..1uri"copayOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier of copay amount (required)
.... extension:coinsuranceRate 1..1ExtensionCo-Insurance Rate
..... extension 0..0
..... url 1..1uri"coinsuranceRate"
..... value[x] 1..1decimalValue of extension
.... extension:coinsuranceOption 1..1ExtensionCo-Insurance Option
..... extension 0..0
..... url 1..1uri"coinsuranceOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier for coinsurance rate (required)
.... url 1..1uri"costSharing"
.... value[x] 0..0
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionDrug Tier Definition
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:drugTierID 1..1ExtensionDrug Tier ID
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..0
.... url 1..1uri"drugTierID"
.... value[x] 1..1CodeableConceptValue of extension
Binding: Drug tier of medication in health plan (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..0
.... url 1..1uri"mailOrder"
.... value[x] 1..1booleanValue of extension
... extension:costSharing 0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 5..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension:pharmacyType 1..1ExtensionPharmacy Type
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"pharmacyType"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Type of pharmacies (extensible)
.... extension:copayAmount 1..1ExtensionCopay Amount
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"copayAmount"
..... value[x] 1..1MoneyValue of extension
.... extension:copayOption 1..1ExtensionCopay Options
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"copayOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier of copay amount (required)
.... extension:coinsuranceRate 1..1ExtensionCo-Insurance Rate
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"coinsuranceRate"
..... value[x] 1..1decimalValue of extension
.... extension:coinsuranceOption 1..1ExtensionCo-Insurance Option
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..0
..... url 1..1uri"coinsuranceOption"
..... value[x] 1..1CodeableConceptValue of extension
Binding: Qualifier for coinsurance rate (required)
.... url 1..1uri"costSharing"
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Extension.extension:drugTierID.value[x]extensibleDrugTierVS
Extension.extension:costSharing.extension:pharmacyType.value[x]extensiblePharmacyTypeVS
Extension.extension:costSharing.extension:copayOption.value[x]requiredCopayOptionVS
Extension.extension:costSharing.extension:coinsuranceOption.value[x]requiredCoinsuranceOptionVS