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 InsurancePlan: PayerInsurancePlanA1002

Generated Narrative

Resource "PayerInsurancePlanA1002" Updated "2021-08-22T18:36:03Z"

Profile: Payer Insurance Plan

identifier: id: A1002

status: active

type: Medicare Advantage (Insurance Product Type#mediadv)

name: Sample Medicare Advantage Plan A1002

period: 2021-01-01 --> 2021-12-31

coverageArea: Location/StateOfCTLocation "State of CT Area"

contact

purpose: Patient (Contact entity type#PATINF)

telecom: +1 (888) 555-1002

contact

purpose: Plan Marketing Information (Codes for type of plan contact#MARKETING)

name: Sample Medicare Advantage Plan Marketing Website

telecom: http://url/to/health/plan/information

contact

purpose: Plan Summary Information (Codes for type of plan contact#SUMMARY)

name: Sample Medicare Advantage Drug Plan Benefit Website

telecom: http://url/to/health/plan/information

contact

purpose: Plan Formulary Information (Codes for type of plan contact#FORMULARY)

name: Sample Medicare Advantage Drug Plan Formulary Website

telecom: http://url/to/health/plan/information

coverage

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

type: drug policy (ActCode#DRUGPOL)

Benefits

-Type
*Drug (Codes for type of plan#drug)

plan

type: Drug (Codes for type of plan#drug)

specificCost

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

benefit

type: Brand (Codes for medication drug tiers in health plans#brand)

cost

type: Copay (Codes for benefit type of cost#copay)

qualifiers: After Deductible (Codes for qualifier of copay amount#after-deductible)

value: 20 $ (Details: urn:iso:std:iso:4217 code USD = 'United States dollar')

cost

type: Coinsurance (Codes for benefit type of cost#coinsurance)

qualifiers: After Deductible (Code for qualifier for coinsurance rate codes#after-deductible)

value: 20 % (Details: UCUM code % = '%')