DaVinci Payer Data Exchange (PDex) US Drug Formulary | STU2 Ballot
1.2.0 - STU2 Ballot

This page is part of the US Drug Formulary (v1.2.0: STU 2 Ballot 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

Example Basic: FormularyItem-D1002-209459

Generated Narrative

Resource "FormularyItem-D1002-209459" Updated "2021-08-22T18:36:03Z"

Profile: Formulary Item

Formulary Reference: InsurancePlan/FormularyD1002 "Sample Medicare Advantage Part D Formulary D1002"

Availability Status: active

Drug Tier ID: Brand (Codes for medication drug tiers in health plans#brand)

Availability Period: 2021-01-01 --> 2021-12-31

Pharmacy Type: 3 month out of network retail (Codes for types of pharmacies#3-month-out-retail)

Prior Authorization: true

Step Therapy Limit: false

Quantity Limit: false

code: Formulary Item (Codes for insurance item type#formulary-item)

subject: MedicationKnowledge/FormularyDrug-209459