DaVinci Payer Data Exchange (PDex) US Drug Formulary
1.0.1 - STU 1.0.1

This page is part of the US Drug Formulary (v1.0.1: STU 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 MedicationKnowledge: Formulary Drug V3001

Generated Narrative

Drug Tier ID: Brand: Brand name drugs that cost more than ‘preferred brand’ drugs.

Prior Authorization: false

Step Therapy Limit: false

Quantity Limit: false

Plan ID: 40308VA0240008

Drug Alternatives: Tylenol Extra Strength 500 MG Oral Tablet. Generated Summary: Tylenol Extra Strength 500 MG Oral Tablet

code: Percocet 5 MG / 325 MG Oral Tablet

Notes:

FieldValue
resourceType "MedicationKnowledge"
id "FormularyDrugV3001"
meta.profile[0]"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"
extension[0].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension"
extension[0].valueCodeableConcept.coding[0].system "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"
extension[0].valueCodeableConcept.coding[0].code #brand
extension[0].valueCodeableConcept.coding[0].display "Brand: Brand name drugs that cost more than ‘preferred brand’ drugs."
extension[1].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension"
extension[1].valueBoolean "false"
extension[2].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension"
extension[2].valueBoolean "false"
extension[3].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension"
extension[3].valueBoolean "false"
extension[4].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanID-extension"
extension[4].valueString "40308VA0240008"
extension[5].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugAlternatives-extension"
extension[5].valueReference.reference "MedicationKnowledge/FormularyDrugV3002"
extension[5].valueReference.display "Tylenol Extra Strength 500 MG Oral Tablet"
code.coding[0].system "http://www.nlm.nih.gov/research/umls/rxnorm"
code.coding[0].code #1049640
code.coding[0].display "Percocet 5 MG / 325 MG Oral Tablet"