DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 United States of America flag

This page is part of the US Drug Formulary (v2.1.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Basic: FormularyItem-D1002-209459

Page standards status: Informative

Generated Narrative: Basic FormularyItem-D1002-209459

Last updated: 2021-08-22 18:36:03+0000

Profile: Formulary Item

Formulary Reference: InsurancePlan Sample Medicare Advantage Part D Formulary D1002

Availability Status: active

Pharmacy Benefit Type: 3 month out of network retail

Drug Tier ID: Brand

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

Prior Authorization: true

Step Therapy Limit: false

Quantity Limit: false

code: Formulary Item

subject: MedicationKnowledge acetaminophen 500 MG Oral Tablet [Tylenol]