DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2 United States of America flag

This page is part of the US Drug Formulary (v2.0.1: STU 2) 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

: Codes for medication drug tiers in health plans - TTL Representation

Page standards status: Trial-use

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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:CodeSystem ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "usdf-DrugTierCS-TEMPORARY-TRIAL-USE"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">generic<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-generic\"> </a></td><td>Generic</td><td>Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.</td></tr><tr><td style=\"white-space:nowrap\">preferred-generic<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-preferred-generic\"> </a></td><td>Preferred Generic</td><td>Commonly prescribed generic drugs.</td></tr><tr><td style=\"white-space:nowrap\">non-preferred-generic<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-non-preferred-generic\"> </a></td><td>Non-preferred Generic</td><td>Generic drugs that cost more than drugs in ‘generic’ tier.</td></tr><tr><td style=\"white-space:nowrap\">specialty<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-specialty\"> </a></td><td>Specialty</td><td>Drugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary.</td></tr><tr><td style=\"white-space:nowrap\">brand<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-brand\"> </a></td><td>Brand</td><td>Brand name drugs that cost more than ‘preferred brand’ drugs.</td></tr><tr><td style=\"white-space:nowrap\">preferred-brand<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-preferred-brand\"> </a></td><td>Preferred Brand</td><td>Brand name drugs</td></tr><tr><td style=\"white-space:nowrap\">non-preferred-brand<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-non-preferred-brand\"> </a></td><td>Non-preferred Brand</td><td>Brand name drugs that cost more than ‘brand’ drugs.</td></tr><tr><td style=\"white-space:nowrap\">zero-cost-share-preventative<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-zero-cost-share-preventative\"> </a></td><td>Zero cost-share preventative</td><td>Preventive medications and products available at no cost.</td></tr><tr><td style=\"white-space:nowrap\">medical-service<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-medical-service\"> </a></td><td>Medical Service</td><td>Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.</td></tr></table></div>"
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "phx" ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
fhir:v "trial-use" ;
      ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary>         ]       ] )     ]
  ] ) ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "2.0.1"] ; # 
  fhir:name [ fhir:v "DrugTierCS"] ; # 
  fhir:title [ fhir:v "Codes for medication drug tiers in health plans"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v "false"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2023-12-01T22:31:50+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International / Pharmacy"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HL7 International / Pharmacy" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/medication" ]     ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "pharmacy@lists.HL7.org" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "Codes to represent the drug tier of a particular medication in a health plan.  Base set are examples.  Each plan may have its own controlled vocabulary."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ]     ] )
  ] ) ; # 
  fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:content [ fhir:v "complete"] ; # 
  fhir:count [ fhir:v "9"^^xsd:nonNegativeInteger] ; # 
  fhir:concept ( [
fhir:code [ fhir:v "generic" ] ;
fhir:display [ fhir:v "Generic" ] ;
fhir:definition [ fhir:v "Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier." ]
  ] [
fhir:code [ fhir:v "preferred-generic" ] ;
fhir:display [ fhir:v "Preferred Generic" ] ;
fhir:definition [ fhir:v "Commonly prescribed generic drugs." ]
  ] [
fhir:code [ fhir:v "non-preferred-generic" ] ;
fhir:display [ fhir:v "Non-preferred Generic" ] ;
fhir:definition [ fhir:v "Generic drugs that cost more than drugs in ‘generic’ tier." ]
  ] [
fhir:code [ fhir:v "specialty" ] ;
fhir:display [ fhir:v "Specialty" ] ;
fhir:definition [ fhir:v "Drugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary." ]
  ] [
fhir:code [ fhir:v "brand" ] ;
fhir:display [ fhir:v "Brand" ] ;
fhir:definition [ fhir:v "Brand name drugs that cost more than ‘preferred brand’ drugs." ]
  ] [
fhir:code [ fhir:v "preferred-brand" ] ;
fhir:display [ fhir:v "Preferred Brand" ] ;
fhir:definition [ fhir:v "Brand name drugs" ]
  ] [
fhir:code [ fhir:v "non-preferred-brand" ] ;
fhir:display [ fhir:v "Non-preferred Brand" ] ;
fhir:definition [ fhir:v "Brand name drugs that cost more than ‘brand’ drugs." ]
  ] [
fhir:code [ fhir:v "zero-cost-share-preventative" ] ;
fhir:display [ fhir:v "Zero cost-share preventative" ] ;
fhir:definition [ fhir:v "Preventive medications and products available at no cost." ]
  ] [
fhir:code [ fhir:v "medical-service" ] ;
fhir:display [ fhir:v "Medical Service" ] ;
fhir:definition [ fhir:v "Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit." ]
  ] ) . #