DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2 United States of America flag

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

ValueSet: Drug tier of medication in health plan

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS Version: 2.0.1
Standards status: Trial-use Computable Name: DrugTierVS

The drug tier of a particular medication in a health plan. The base set are examples. Each plan may have its own controlled vocabulary.

References

Logical Definition (CLD)

 

Expansion

Expansion based on codesystem Codes for medication drug tiers in health plans v2.0.1 (CodeSystem)

This value set contains 9 concepts

CodeSystemDisplayDefinition
  generichttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEGeneric

Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.

  preferred-generichttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEPreferred Generic

Commonly prescribed generic drugs.

  non-preferred-generichttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USENon-preferred Generic

Generic drugs that cost more than drugs in ‘generic’ tier.

  specialtyhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USESpecialty

Drugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary.

  brandhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEBrand

Brand name drugs that cost more than ‘preferred brand’ drugs.

  preferred-brandhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEPreferred Brand

Brand name drugs

  non-preferred-brandhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USENon-preferred Brand

Brand name drugs that cost more than ‘brand’ drugs.

  zero-cost-share-preventativehttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEZero cost-share preventative

Preventive medications and products available at no cost.

  medical-servicehttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEMedical Service

Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code