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 InsurancePlan: PayerInsurancePlanA1002

Page standards status: Informative

Generated Narrative: InsurancePlan PayerInsurancePlanA1002

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

Profile: Payer Insurance Plan

identifier: A1002

status: Active

type: Medicare Advantage

name: Sample Medicare Advantage Plan A1002

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

coverageArea: Location State of CT Area

contact

purpose: Patient

telecom: +1 (888) 555-1002

contact

purpose: Marketting

name: Sample Medicare Advantage Plan Marketing Website

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

contact

purpose: Summary

name: Sample Medicare Advantage Drug Plan Benefit Website

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

contact

purpose: Formulary

name: Sample Medicare Advantage Drug Plan Formulary Website

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

coverage

Formulary Reference: InsurancePlan Sample Medicare Advantage Part D Formulary D1002

type: drug policy

Benefits

-Type
*Drug

plan

type: Drug

specificCost

category: 1 month in network retail

benefit

type: Brand

cost

type: Copay

qualifiers: After Deductible

value: 20 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

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