US Drug Formulary STU Ballot
This page is part of the US Drug Formulary (v0.1.0: STU 1 Draft) 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 
{
"resourceType" : "List",
"id" : "CoveragePlanV3002",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-05-22T18:36:03.000+00:00",
"profile" : [
"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>*** CoveragePlan Example #1 (Reference to MedicationKnowledge) ***</b></p><p><b>id</b>: covplanV2001</p><p><b>Plan Name</b>: Sample Gold Health Plan</p><p><b>Drug Product</b>: <i>(Generated Detail from id - formularydrugV1001):</i> Acetaminophen 325 MG / Oxycodone Hydrochloride 5 MG Oral Tablet [Percocet]</p><p><b>Status</b>: current </p><p><b>Drug Tier ID</b>: Brand </p><p><b>Mail order</b>: false </p><p><b>Pharmacy type</b>: 1-MONTH-IN-RETAIL</p><p><b>Copay Amount</b>: 20.0</p><p><b>Copay option</b>: AFTER-DEDUCTIBLE</p><p><b>Coinsurance rate</b>: 0.20</p><p><b>Coinsurance option</b>: AFTER-DEDUCTIBLE</p></div>"
},
"extension" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS",
"code" : "GENERIC",
"display" : "Generic"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MailOrder-extension",
"valueBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyType-extension",
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"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyTypeCS",
"code" : "1-MONTH-IN-RETAIL",
"display" : "1 Month Supply via in-network retail pharmacy"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayAmount-extension",
"valueMoney" : {
"value" : 10
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{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayOption-extension",
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"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS",
"code" : "BEFORE-DEDUCTIBLE",
"display" : "Before Deductible"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoInsuranceRate-extension",
"valueDecimal" : 1
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoinsuranceOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS",
"code" : "AFTER-DEDUCTIBLE",
"display" : "After Deductible"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CostSharing-extension"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyType-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyTypeCS",
"code" : "1-MONTH-OUT-RETAIL",
"display" : "1 Month Supply via out-of-network retail pharmacy"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayAmount-extension",
"valueMoney" : {
"value" : 0
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS",
"code" : "NO-CHARGE",
"display" : "No Charge"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoInsuranceRate-extension",
"valueDecimal" : 0
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoinsuranceOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS",
"code" : "AFTER-DEDUCTIBLE",
"display" : "After Deductible"
}
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}
}
],
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CostSharing-extension"
},
{
"extension" : [
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"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyType-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyTypeCS",
"code" : "3-MONTH-IN-RETAIL",
"display" : "3 Month Supply via in-network retail pharmacy"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayAmount-extension",
"valueMoney" : {
"value" : 0
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{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS",
"code" : "NO-CHARGE",
"display" : "No Charge"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoInsuranceRate-extension",
"valueDecimal" : 0
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoinsuranceOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS",
"code" : "AFTER-DEDUCTIBLE",
"display" : "After Deductible"
}
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}
}
],
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CostSharing-extension"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyType-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyTypeCS",
"code" : "3-MONTH-OUT-RETAIL",
"display" : "3 Month Supply via out-of-network retail pharmacy"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayAmount-extension",
"valueMoney" : {
"value" : 0
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CopayOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS",
"code" : "NO-CHARGE",
"display" : "No Charge"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoInsuranceRate-extension",
"valueDecimal" : 0
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoinsuranceOption-extension",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS",
"code" : "AFTER-DEDUCTIBLE",
"display" : "After Deductible"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CostSharing-extension"
}
],
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension",
"valueString" : "https://content.carefirst.com/sbc/D,$0/ D,$0/ D,$0/ D,$0/ D,$0B+"
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension",
"valueString" : "http://url/to/formulary/information"
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension",
"valueString" : "http://url/to/formulary/information"
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension",
"valueString" : "Patrick.Breen@carefirst.com"
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension",
"valueString" : "PREFERRED"
},
{
"url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension",
"valueString" : "HIOS-PLAN-ID"
}
],
"identifier" : [
{
"value" : "test1"
}
],
"status" : "current",
"mode" : "snapshot",
"title" : "Sample Gold Health Plan",
"date" : "2015-06-12",
"entry" : [
{
"item" : {
"reference" : "MedicationKnowledge/FormularyDrugV3001"
}
}
]
}
©2019+
HL7 Pharmacy WG.
Package hl7.fhir.us.davinci-drug-formulary#0.1.0 based on FHIR 4.0.0.
Generated 2019-06-21.
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