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

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: Formulary Drug V1002 - XML Representation

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<MedicationKnowledge xmlns="http://hl7.org/fhir">
  <id value="formularydrugV1002"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>Drug Tier ID</b>: <span title="Codes: {http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS brand}">Brand: Brand name drugs that cost more than ‘preferred brand’ drugs.</span></p><p><b>Prior Authorization</b>: false</p><p><b>Step Therapy Limit</b>: false</p><p><b>Quantity Limit</b>: false</p><p><b>Plan ID</b>: 40308VA0240008</p><p><b>code</b>: <span title="Codes: {http://www.nlm.nih.gov/research/umls/rxnorm 1049640}">Percocet 5 MG / 325 MG Oral Tablet</span></p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
        <code value="brand"/>
        <display
                 value="Brand: Brand name drugs that cost more than ‘preferred brand’ drugs."/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension">
    <valueBoolean value="false"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension">
    <valueBoolean value="false"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension">
    <valueBoolean value="false"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanID-extension">
    <valueString value="40308VA0240008"/>
  </extension>
  <code>
    <coding>
      <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
      <code value="1049640"/>
      <display value="Percocet 5 MG / 325 MG Oral Tablet"/>
    </coding>
  </code>
</MedicationKnowledge>