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

: FormularyItem-D3004t-1049640 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Basic;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "FormularyItem-D3004t-1049640"];
  fhir:Resource.meta [
     fhir:Meta.lastUpdated [ fhir:value "2021-08-22T18:36:03.000+00:00"^^xsd:dateTime ];
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyItem";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyItem>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"FormularyItem-D3004t-1049640\" Updated \"2021-08-22T18:36:03Z\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-usdf-FormularyItem.html\">Formulary Item</a></p></div><p><b>Formulary Reference</b>: <a href=\"InsurancePlan-FormularyD3004t.html\">InsurancePlan/FormularyD3004t</a> \"Sample Medicare Advantage Part D Formulary D3004t\"</p><p><b>Availability Status</b>: active</p><p><b>Drug Tier ID</b>: Preferred Brand <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-usdf-DrugTierCS.html\">Codes for medication drug tiers in health plans</a>#preferred-brand)</span></p><p><b>Availability Period</b>: 2021-01-01 --&gt; 2021-12-31</p><p><b>Pharmacy Type</b>: 3 month out of network retail <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-usdf-PharmacyTypeCS.html\">Codes for types of pharmacies</a>#3-month-out-retail)</span></p><p><b>Prior Authorization</b>: true</p><p><b>Prior Authorization New Starts Only</b>: true</p><p><b>Step Therapy Limit</b>: true</p><p><b>Step Therapy Limit New Starts Only</b>: false</p><p><b>Quantity Limit</b>: true</p><p><b>code</b>: Formulary Item <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-usdf-InsuranceItemTypeCS.html\">Codes for insurance item type</a>#formulary-item)</span></p><p><b>subject</b>: <a href=\"MedicationKnowledge-FormularyDrug-1049640.html\">MedicationKnowledge/FormularyDrug-1049640</a></p></div>"
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension" ];
     fhir:Extension.valueReference [
       fhir:Reference.reference [ fhir:value "InsurancePlan/FormularyD3004t" ]     ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension" ];
     fhir:Extension.valueCode [ fhir:value "active" ]
  ], [
     fhir:index 2;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension" ];
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS" ];
         fhir:Coding.code [ fhir:value "preferred-brand" ];
         fhir:Coding.display [ fhir:value "Preferred Brand" ]       ]     ]
  ], [
     fhir:index 3;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension" ];
     fhir:Extension.valuePeriod [
       fhir:Period.start [ fhir:value "2021-01-01"^^xsd:date ];
       fhir:Period.end [ fhir:value "2021-12-31"^^xsd:date ]     ]
  ], [
     fhir:index 4;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyType-extension" ];
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyTypeCS" ];
         fhir:Coding.code [ fhir:value "3-month-out-retail" ];
         fhir:Coding.display [ fhir:value "3 month out of network retail" ]       ]     ]
  ], [
     fhir:index 5;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension" ];
     fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]
  ], [
     fhir:index 6;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension" ];
     fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]
  ], [
     fhir:index 7;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension" ];
     fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]
  ], [
     fhir:index 8;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension" ];
     fhir:Extension.valueBoolean [ fhir:value "false"^^xsd:boolean ]
  ], [
     fhir:index 9;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension" ];
     fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]
  ];
  fhir:Basic.code [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS" ];
       fhir:Coding.code [ fhir:value "formulary-item" ];
       fhir:Coding.display [ fhir:value "Formulary Item" ]     ]
  ];
  fhir:Basic.subject [
     fhir:Reference.reference [ fhir:value "MedicationKnowledge/FormularyDrug-1049640" ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.