DaVinci Payer Data Exchange (PDex) US Drug Formulary STU 1

This page is part of the US Drug Formulary (v1.0.0: 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

DrugTierDefinition

 

The official URL for this extension is: 

http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension

A description of the drug tiers used by the formulary and how those tiers implement copay and coinsurance amounts. Drug tiers do not have any inherent meaning that is consistent across all formularies. Rather, each tier is defined using this element.

This extension was published on Fri Jan 17 00:00:00 UTC 2020 as a draft by HL7 Pharmacy WG.

Summary

Mandatory: 4 elements (10 nested mandatory elements)
Fixed Value: 9 elements
Prohibited: 9 elements

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionDrugTierDefinition
... extension 2..*Extension
... extension:drugTierID 1..1Extension
.... extension 0..0
.... url 1..1uri"drugTierID"
.... valueCodeableConcept 1..1CodeableConceptBinding: Drug Tier VS (extensible)
... extension:mailOrder 1..1Extension
.... extension 0..0
.... url 1..1uri"mailOrder"
.... valueBoolean 1..1boolean
... extension:costSharing 0..*Extension
.... extension 5..*Extension
.... extension:pharmacyType 1..1Extension
..... extension 0..0
..... url 1..1uri"pharmacyType"
..... valueCodeableConcept 1..1CodeableConceptBinding: Pharmacy Type VS (extensible)
.... extension:copayAmount 1..1Extension
..... extension 0..0
..... url 1..1uri"copayAmount"
..... valueMoney 1..1Money
.... extension:copayOption 1..1Extension
..... extension 0..0
..... url 1..1uri"copayOption"
..... valueCodeableConcept 1..1CodeableConceptBinding: Copay Option VS (required)
.... extension:coinsuranceRate 1..1Extension
..... extension 0..0
..... url 1..1uri"coinsuranceRate"
..... valueDecimal 1..1decimal
.... extension:coinsuranceOption 1..1Extension
..... extension 0..0
..... url 1..1uri"coinsuranceOption"
..... valueCodeableConcept 1..1CodeableConceptBinding: Coinsurance Option VS (required)
.... url 1..1uri"costSharing"
.... value[x] 0..0
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension I0..*ExtensionDrugTierDefinition
... id 0..1stringUnique id for inter-element referencing
... extension I2..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:drugTierID I1..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..0
.... url 1..1uri"drugTierID"
.... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
..... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Drug Tier VS (extensible)
... extension:mailOrder I1..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..0
.... url 1..1uri"mailOrder"
.... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
..... value[x]:valueBoolean I1..1booleanValue of extension
... extension:costSharing I0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension I5..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension:pharmacyType I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"pharmacyType"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Pharmacy Type VS (extensible)
.... extension:copayAmount I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"copayAmount"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueMoney I1..1MoneyValue of extension
.... extension:copayOption I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"copayOption"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Copay Option VS (required)
.... extension:coinsuranceRate I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"coinsuranceRate"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueDecimal I1..1decimalValue of extension
.... extension:coinsuranceOption I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"coinsuranceOption"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Coinsurance Option VS (required)
.... url 1..1uri"costSharing"
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"

doco Documentation for this format

Summary

Mandatory: 4 elements (10 nested mandatory elements)
Fixed Value: 9 elements
Prohibited: 9 elements

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionDrugTierDefinition
... extension 2..*Extension
... extension:drugTierID 1..1Extension
.... extension 0..0
.... url 1..1uri"drugTierID"
.... valueCodeableConcept 1..1CodeableConceptBinding: Drug Tier VS (extensible)
... extension:mailOrder 1..1Extension
.... extension 0..0
.... url 1..1uri"mailOrder"
.... valueBoolean 1..1boolean
... extension:costSharing 0..*Extension
.... extension 5..*Extension
.... extension:pharmacyType 1..1Extension
..... extension 0..0
..... url 1..1uri"pharmacyType"
..... valueCodeableConcept 1..1CodeableConceptBinding: Pharmacy Type VS (extensible)
.... extension:copayAmount 1..1Extension
..... extension 0..0
..... url 1..1uri"copayAmount"
..... valueMoney 1..1Money
.... extension:copayOption 1..1Extension
..... extension 0..0
..... url 1..1uri"copayOption"
..... valueCodeableConcept 1..1CodeableConceptBinding: Copay Option VS (required)
.... extension:coinsuranceRate 1..1Extension
..... extension 0..0
..... url 1..1uri"coinsuranceRate"
..... valueDecimal 1..1decimal
.... extension:coinsuranceOption 1..1Extension
..... extension 0..0
..... url 1..1uri"coinsuranceOption"
..... valueCodeableConcept 1..1CodeableConceptBinding: Coinsurance Option VS (required)
.... url 1..1uri"costSharing"
.... value[x] 0..0
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension I0..*ExtensionDrugTierDefinition
... id 0..1stringUnique id for inter-element referencing
... extension I2..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:drugTierID I1..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..0
.... url 1..1uri"drugTierID"
.... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
..... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Drug Tier VS (extensible)
... extension:mailOrder I1..1ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..0
.... url 1..1uri"mailOrder"
.... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
..... value[x]:valueBoolean I1..1booleanValue of extension
... extension:costSharing I0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension I5..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension:pharmacyType I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"pharmacyType"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Pharmacy Type VS (extensible)
.... extension:copayAmount I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"copayAmount"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueMoney I1..1MoneyValue of extension
.... extension:copayOption I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"copayOption"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Copay Option VS (required)
.... extension:coinsuranceRate I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"coinsuranceRate"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueDecimal I1..1decimalValue of extension
.... extension:coinsuranceOption I1..1ExtensionExtension
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..0
..... url 1..1uri"coinsuranceOption"
..... value[x] I1..1(Slice Definition)Value of extension
Slice: Unordered, Closed by type:$this
...... value[x]:valueCodeableConcept I1..1CodeableConceptValue of extension
Binding: Coinsurance Option VS (required)
.... url 1..1uri"costSharing"
... url 1..1uri"http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension"

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON, TTL), Schema: XML Schematron

 

Terminology Bindings

PathConformanceValueSet
Extension.extension:drugTierID.value[x]:valueCodeableConceptextensibleDrugTierVS
Extension.extension:costSharing.extension:pharmacyType.value[x]:valueCodeableConceptextensiblePharmacyTypeVS
Extension.extension:costSharing.extension:copayOption.value[x]:valueCodeableConceptrequiredCopayOptionVS
Extension.extension:costSharing.extension:coinsuranceOption.value[x]:valueCodeableConceptrequiredCoinsuranceOptionVS

 

Constraints

IdPathDetailsRequirements
ele-1ExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:drugTierIDAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:drugTierIDMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:drugTierID.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:drugTierID.value[x]:valueCodeableConceptAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:mailOrderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:mailOrderMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:mailOrder.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:mailOrder.value[x]:valueBooleanAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharingMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharing.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extension:pharmacyTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharing.extension:pharmacyTypeMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extension:pharmacyType.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:pharmacyType.value[x]:valueCodeableConceptAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:copayAmountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharing.extension:copayAmountMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extension:copayAmount.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:copayAmount.value[x]:valueMoneyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:copayOptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharing.extension:copayOptionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extension:copayOption.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:copayOption.value[x]:valueCodeableConceptAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:coinsuranceRateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharing.extension:coinsuranceRateMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extension:coinsuranceRate.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:coinsuranceRate.value[x]:valueDecimalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:coinsuranceOptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1Extension.extension:costSharing.extension:coinsuranceOptionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Extension.extension:costSharing.extension:coinsuranceOption.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1Extension.extension:costSharing.extension:coinsuranceOption.value[x]:valueCodeableConceptAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())

 

Usage

This extension is used in the following profiles: