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. 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-FormularyItem | Version: 2.0.1 | |||
| Standards status: Trial-use | Computable Name: FormularyItem | |||
A resource that describes a drug’s relationship to a drug plan, including drug tier, prior authorization requirements, and more. The set of FormularyItem resources associated with a particular drug plan represents the drug plans formulary.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Basic
| Path | Conformance | ValueSet / Code |
| Basic.code | example | Pattern: formulary-item |
| Path | Conformance | ValueSet / Code | ||||
| Basic.meta.security | extensible | All Security Labels | ||||
| Basic.meta.tag | example | CommonTags | ||||
| Basic.language | preferred | CommonLanguages
| ||||
| Basic.code | example | Pattern: formulary-item |
This structure is derived from Basic
Summary
Mandatory: 5 elements (1 nested mandatory element)
Must-Support: 10 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
This structure is derived from Basic
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Basic | 0..* | Basic | Resource for non-supported content | |
  meta | ||||
  lastUpdated | S | 1..1 | instant | When the resource version last changed |
  Slices for extension | 4..* | Extension | Extension Slice: Unordered, Open by value:url | |
 usdf-FormularyReference-extension | S | 1..1 | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| usdf-AvailabilityStatus-extension | S | 1..1 | code | Availability Status URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension Binding: PublicationStatus (required) |
| usdf-AvailabilityPeriod-extension | S | 0..1 | Period | Availability Period URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension |
| usdf-PharmacyBenefitType-extension | S | 1..* | CodeableConcept | Pharmacy Benefit Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension Binding: Pharmacy benefit types (extensible) |
| usdf-DrugTierID-extension | S | 1..1 | CodeableConcept | Drug Tier ID URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension Binding: Drug tier of medication in health plan (extensible) |
| usdf-PriorAuthorization-extension | S | 0..1 | boolean | Prior Authorization URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension |
| usdf-PriorAuthorizationNewStartsOnly-extension | 0..1 | boolean | Prior Authorization New Starts Only URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension | |
| usdf-StepTherapyLimit-extension | S | 0..1 | boolean | Step Therapy Limit URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension |
| usdf-StepTherapyLimitNewStartsOnly-extension | 0..1 | boolean | Step Therapy Limit New Starts Only URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension | |
| usdf-QuantityLimit-extension | S | 0..1 | boolean | Quantity Limit URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension |
| usdf-QuantityLimitDetail-extension | 0..1 | (Complex) | Quantity Limit Detail URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimitDetail-extension | |
| usdf-AdditionalCoverageInformation-extension | 0..1 | markdown | Additional Coverage Information URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension | |
| code | 1..1 | CodeableConcept | Kind of Resource 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://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: formulary-item | |
 subject | S | 1..1 | Reference(Formulary Drug) | Identifies the focus of this resource |
| Documentation for this format | ||||
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Basic | 0..* | Basic | Resource for non-supported content | |
 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 |
| Slices for extension | 4..* | Extension | Extension Slice: Unordered, Open by value:url | |
| usdf-FormularyReference-extension | S | 1..1 | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| usdf-AvailabilityStatus-extension | S | 1..1 | code | Availability Status URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension Binding: PublicationStatus (required) |
| usdf-AvailabilityPeriod-extension | S | 0..1 | Period | Availability Period URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension |
| usdf-PharmacyBenefitType-extension | S | 1..* | CodeableConcept | Pharmacy Benefit Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension Binding: Pharmacy benefit types (extensible) |
| usdf-DrugTierID-extension | S | 1..1 | CodeableConcept | Drug Tier ID URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension Binding: Drug tier of medication in health plan (extensible) |
| usdf-PriorAuthorization-extension | S | 0..1 | boolean | Prior Authorization URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension |
| usdf-PriorAuthorizationNewStartsOnly-extension | 0..1 | boolean | Prior Authorization New Starts Only URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension | |
| usdf-StepTherapyLimit-extension | S | 0..1 | boolean | Step Therapy Limit URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension |
| usdf-StepTherapyLimitNewStartsOnly-extension | 0..1 | boolean | Step Therapy Limit New Starts Only URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension | |
| usdf-QuantityLimit-extension | S | 0..1 | boolean | Quantity Limit URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension |
| usdf-QuantityLimitDetail-extension | 0..1 | (Complex) | Quantity Limit Detail URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimitDetail-extension | |
| usdf-AdditionalCoverageInformation-extension | 0..1 | markdown | Additional Coverage Information URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| code | ?!Σ | 1..1 | CodeableConcept | Kind of Resource Binding: BasicResourceTypes (example): Codes for identifying types of resources not yet defined by FHIR. 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://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: formulary-item | |
| subject | SΣ | 1..1 | Reference(Formulary Drug) | Identifies the focus of this resource |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code |
| Basic.code | example | Pattern: formulary-item |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Basic | 0..* | Basic | Resource for non-supported content | |||||
| 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 | |||||
| Slices for extension | 4..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| usdf-FormularyReference-extension | S | 1..1 | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension | ||||
| usdf-AvailabilityStatus-extension | S | 1..1 | code | Availability Status URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension Binding: PublicationStatus (required) | ||||
| usdf-AvailabilityPeriod-extension | S | 0..1 | Period | Availability Period URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension | ||||
| usdf-PharmacyBenefitType-extension | S | 1..* | CodeableConcept | Pharmacy Benefit Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension Binding: Pharmacy benefit types (extensible) | ||||
| usdf-DrugTierID-extension | S | 1..1 | CodeableConcept | Drug Tier ID URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension Binding: Drug tier of medication in health plan (extensible) | ||||
| usdf-PriorAuthorization-extension | S | 0..1 | boolean | Prior Authorization URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension | ||||
| usdf-PriorAuthorizationNewStartsOnly-extension | 0..1 | boolean | Prior Authorization New Starts Only URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension | |||||
| usdf-StepTherapyLimit-extension | S | 0..1 | boolean | Step Therapy Limit URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension | ||||
| usdf-StepTherapyLimitNewStartsOnly-extension | 0..1 | boolean | Step Therapy Limit New Starts Only URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension | |||||
| usdf-QuantityLimit-extension | S | 0..1 | boolean | Quantity Limit URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension | ||||
| usdf-QuantityLimitDetail-extension | 0..1 | (Complex) | Quantity Limit Detail URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimitDetail-extension | |||||
| usdf-AdditionalCoverageInformation-extension | 0..1 | markdown | Additional Coverage Information URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | Σ | 0..* | Identifier | Business identifier | ||||
| code | ?!Σ | 1..1 | CodeableConcept | Kind of Resource Binding: BasicResourceTypes (example): Codes for identifying types of resources not yet defined by FHIR. 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://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: formulary-item | |||||
| 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 | |||||
| subject | SΣ | 1..1 | Reference(Formulary Drug) | Identifies the focus of this resource | ||||
| created | Σ | 0..1 | date | When created | ||||
| author | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) | Who created | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | ||||
| Basic.meta.security | extensible | All Security Labels | ||||
| Basic.meta.tag | example | CommonTags | ||||
| Basic.language | preferred | CommonLanguages
| ||||
| Basic.code | example | Pattern: formulary-item |
This structure is derived from Basic
Summary
Mandatory: 5 elements (1 nested mandatory element)
Must-Support: 10 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
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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