DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2
DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2
This page is part of the US Drug Formulary (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Formulary | Version: 2.0.1 | |||
| Standards status: Trial-use | Computable Name: Formulary | |||
The Formulary provides general information about a formulary and acts as an organizing construct that associated FormularyItem resources point to. The Formulary combined with its associated FormularyItem and FormularyDrug resources represent a formulary list that includes the set of drugs covered and the requirements and limitations of the coverage.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  InsurancePlan | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
  meta | ||||
  lastUpdated | S | 1..1 | instant | When the resource version last changed |
 identifier | S | 1..* | Identifier | Business Identifier for Product |
| status | S | 1..1 | code | draft | active | retired | unknown |
| type | S | 1..1 | CodeableConcept | Plan type Required Pattern: At least the following |
  coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
 system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name | S | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| plan | 0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost | 0..* | BackboneElement | Pharmacy benefit type specific cost | |
| category | 1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |
| benefit | 0..* | BackboneElement | Drug tier benefit | |
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
 meta | Σ | 0..1 | Meta | Metadata about the resource |
 lastUpdated | SΣ | 1..1 | instant | When the resource version last changed |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name | SΣC | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| plan | 0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost | 0..* | BackboneElement | Pharmacy benefit type specific cost | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | 1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |
| benefit | 0..* | BackboneElement | Drug tier benefit | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | example | Pattern: DRUGPOL |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
 extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product | ||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type | SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| name | SΣC | 0..1 | string | Official name | ||||
| alias | 0..* | string | Alternate names | |||||
| period | S | 0..1 | Period | When the product is available | ||||
 ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| contact | 0..* | BackboneElement | Contact for the product | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | |||||
| name | 0..1 | HumanName | A name associated with the contact | |||||
| telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||
| network | 0..* | Reference(Organization) | What networks are Included | |||||
| coverage | 0..* | BackboneElement | Coverage details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of coverage | |||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit | 1..* | BackboneElement | List of benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| plan | 0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | 0..* | BackboneElement | Pharmacy benefit type specific cost | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |||||
| benefit | 0..* | BackboneElement | Drug tier benefit | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |||||
| cost | 0..* | BackboneElement | List of the costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | ||||
| InsurancePlan.meta.security | extensible | All Security Labels | ||||
| InsurancePlan.meta.tag | example | CommonTags | ||||
| InsurancePlan.language | preferred | CommonLanguages
| ||||
| InsurancePlan.status | required | PublicationStatus | ||||
| InsurancePlan.type | example | Pattern: DRUGPOL | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityType | ||||
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) | ||||
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
This structure is derived from InsurancePlan
Differential View
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
| meta | ||||
| lastUpdated | S | 1..1 | instant | When the resource version last changed |
| identifier | S | 1..* | Identifier | Business Identifier for Product |
| status | S | 1..1 | code | draft | active | retired | unknown |
| type | S | 1..1 | CodeableConcept | Plan type Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name | S | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| plan | 0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost | 0..* | BackboneElement | Pharmacy benefit type specific cost | |
| category | 1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |
| benefit | 0..* | BackboneElement | Drug tier benefit | |
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name | SΣC | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| plan | 0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost | 0..* | BackboneElement | Pharmacy benefit type specific cost | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | 1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |
| benefit | 0..* | BackboneElement | Drug tier benefit | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | example | Pattern: DRUGPOL |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product | ||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type | SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| name | SΣC | 0..1 | string | Official name | ||||
| alias | 0..* | string | Alternate names | |||||
| period | S | 0..1 | Period | When the product is available | ||||
| ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| contact | 0..* | BackboneElement | Contact for the product | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | |||||
| name | 0..1 | HumanName | A name associated with the contact | |||||
| telecom | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||
| network | 0..* | Reference(Organization) | What networks are Included | |||||
| coverage | 0..* | BackboneElement | Coverage details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of coverage | |||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit | 1..* | BackboneElement | List of benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| plan | 0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | 0..* | BackboneElement | Pharmacy benefit type specific cost | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |||||
| benefit | 0..* | BackboneElement | Drug tier benefit | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |||||
| cost | 0..* | BackboneElement | List of the costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | ||||
| InsurancePlan.meta.security | extensible | All Security Labels | ||||
| InsurancePlan.meta.tag | example | CommonTags | ||||
| InsurancePlan.language | preferred | CommonLanguages
| ||||
| InsurancePlan.status | required | PublicationStatus | ||||
| InsurancePlan.type | example | Pattern: DRUGPOL | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityType | ||||
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) | ||||
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability |
This structure is derived from InsurancePlan
Other representations of profile: CSV, Excel, Schematron
IG © 2022+ HL7 International / Pharmacy. Package hl7.fhir.us.davinci-drug-formulary#2.0.1 based on FHIR 4.0.1. Generated 2023-12-01
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