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 cmsip9

Generated Narrative

Drug Tier ID: Generic: Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.

Prior Authorization: false

Step Therapy Limit: true

Quantity Limit: true

Plan ID: 40308VA0240008

code: doxepin HCl 5 % Topical Cream

Notes:

FieldValue
code.coding[0].code #1000091
code.coding[0].system "http://www.nlm.nih.gov/research/umls/rxnorm"
code.coding[0].display "doxepin HCl 5 % Topical Cream"
extension[0].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension"
extension[0].valueCodeableConcept.coding[0].code #generic
extension[0].valueCodeableConcept.coding[0].system "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"
extension[0].valueCodeableConcept.coding[0].display "Generic: Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier."
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 "true"
extension[3].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension"
extension[3].valueBoolean "true"
extension[4].url "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanID-extension"
extension[4].valueString "40308VA0240008"
resourceType "MedicationKnowledge"
meta.profile[0]"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"
id "cmsip9"