DaVinci Payer Data Exchange (PDex) US Drug Formulary
1.1.0 - STU 1.1

This page is part of the US Drug Formulary (v1.1.0: 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

: Formulary Drug V3002 - JSON Representation

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{
  "resourceType" : "MedicationKnowledge",
  "id" : "FormularyDrugV3002",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<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</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>Mail Order</b>: true</p><p><b>Plan ID</b>: 40308VA0240008</p><p><b>code</b>: <span title=\"Codes: {http://www.nlm.nih.gov/research/umls/rxnorm 209459}\">acetaminophen 500 MG Oral Tablet [Tylenol]</span></p></div>"
  },
  "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" : "brand",
            "display" : "Brand"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension",
      "valueBoolean" : false
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension",
      "valueBoolean" : false
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension",
      "valueBoolean" : false
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MailOrder-extension",
      "valueBoolean" : true
    },
    {
      "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanID-extension",
      "valueString" : "40308VA0240008"
    }
  ],
  "code" : {
    "coding" : [
      {
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "209459",
        "display" : "acetaminophen 500 MG Oral Tablet [Tylenol]"
      }
    ]
  }
}