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

ValueSet: Drug tier of medication in health plan

Summary

Defining URL:http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS
Version:1.1.0
Name:DrugTierVS
Title:Drug tier of medication in health plan
Status:Active as of 2021-10-15T15:46:55+00:00
Definition:

The drug tier of a particular medication in a health plan. The base set are examples. Each plan may have its own controlled vocabulary.

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

References

Logical Definition (CLD)

 

Expansion

This value set contains 9 concepts

Expansion based on Codes for medication drug tiers in health plans v1.1.0 (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS

CodeDisplayDefinition
genericGenericCommonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.
preferred-genericPreferred GenericCommonly prescribed generic drugs.
non-preferred-genericNon-preferred GenericGeneric drugs that cost more than drugs in ‘generic’ tier.
specialtySpecialtyDrugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary.
brandBrandBrand name drugs that cost more than ‘preferred brand’ drugs.
preferred-brandPreferred BrandBrand name drugs
non-preferred-brandNon-preferred BrandBrand name drugs that cost more than ‘brand’ drugs.
zero-cost-share-preventativeZero cost-share preventativePreventive medications and products available at no cost.
medical-serviceMedical ServiceDrugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code