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-D3002-1000091

Generated Narrative

Resource "FormularyItem-D3002-1000091" Updated "2021-08-22T18:36:03Z"

Profile: Formulary Item

Formulary Reference: InsurancePlan/FormularyD3002 "Sample Medicare Advantage Part D Formulary D3002"

Availability Status: active

Drug Tier ID: Generic (Codes for medication drug tiers in health plans#generic)

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

Pharmacy Type: 1 month in network retail (Codes for types of pharmacies#1-month-in-retail)

Pharmacy Type: 1 month in network mail order (Codes for types of pharmacies#1-month-in-mail)

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

Pharmacy Type: 3 month in network mail order (Codes for types of pharmacies#3-month-in-mail)

Prior Authorization: false

Step Therapy Limit: true

Step Therapy Limit New Starts Only: true

Quantity Limit: true

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

subject: MedicationKnowledge/FormularyDrug-1000091