DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.0 - STU 2 US

This page is part of the US Drug Formulary (v2.0.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: Formulary Item

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyItem Version: 2.0.0
Active as of 2022-08-25 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:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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:

This structure is derived from Basic

NameFlagsCard.TypeDescription & Constraintsdoco
.. Basic 0..*BasicResource for non-supported content
... meta
.... lastUpdated S1..1instantWhen the resource version last changed
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-FormularyReference-extension S1..1Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
... usdf-AvailabilityPeriod-extension S0..1PeriodAvailability Period
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension
... usdf-PharmacyBenefitType-extension S1..*CodeableConceptPharmacy Benefit Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension
Binding: Pharmacy benefit types (extensible)
... usdf-DrugTierID-extension S1..1CodeableConceptDrug 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 S0..1booleanPrior Authorization
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension
... usdf-PriorAuthorizationNewStartsOnly-extension 0..1booleanPrior Authorization New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension
... usdf-StepTherapyLimit-extension S0..1booleanStep Therapy Limit
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension
... usdf-StepTherapyLimitNewStartsOnly-extension 0..1booleanStep Therapy Limit New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension
... usdf-QuantityLimit-extension S0..1booleanQuantity 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..1markdownAdditional Coverage Information
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension
... code 1..1CodeableConceptKind of Resource
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: formulary-item
... subject S1..1Reference(Formulary Drug)Identifies the focus of this resource

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Basic 0..*BasicResource for non-supported content
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags 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 ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-FormularyReference-extension S1..1Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
... usdf-AvailabilityStatus-extension S1..1codeAvailability Status
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension
Binding: PublicationStatus (required)
... usdf-AvailabilityPeriod-extension S0..1PeriodAvailability Period
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension
... usdf-PharmacyBenefitType-extension S1..*CodeableConceptPharmacy Benefit Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension
Binding: Pharmacy benefit types (extensible)
... usdf-DrugTierID-extension S1..1CodeableConceptDrug 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 S0..1booleanPrior Authorization
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension
... usdf-PriorAuthorizationNewStartsOnly-extension 0..1booleanPrior Authorization New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension
... usdf-StepTherapyLimit-extension S0..1booleanStep Therapy Limit
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension
... usdf-StepTherapyLimitNewStartsOnly-extension 0..1booleanStep Therapy Limit New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension
... usdf-QuantityLimit-extension S0..1booleanQuantity 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..1markdownAdditional Coverage Information
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness identifier
... code ?!Σ1..1CodeableConceptKind of Resource
Binding: BasicResourceTypes (example): Codes for identifying types of resources not yet defined by FHIR.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: formulary-item
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(Formulary Drug)Identifies the focus of this resource
... created Σ0..1dateWhen created
... author Σ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)Who created

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Basic 0..*BasicResource for non-supported content
... meta Σ0..1MetaMetadata about the resource
.... lastUpdated Σ1..1instantWhen the resource version last changed
... usdf-FormularyReference-extension 1..1Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
... usdf-AvailabilityStatus-extension 1..1codeAvailability Status
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension
Binding: PublicationStatus (required)
... usdf-PharmacyBenefitType-extension 1..*CodeableConceptPharmacy Benefit Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension
Binding: Pharmacy benefit types (extensible)
... usdf-DrugTierID-extension 1..1CodeableConceptDrug 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 0..1booleanPrior Authorization
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension
... usdf-StepTherapyLimit-extension 0..1booleanStep Therapy Limit
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension
... usdf-QuantityLimit-extension 0..1booleanQuantity Limit
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension
... subject Σ1..1Reference(Formulary Drug)Identifies the focus of this resource

doco Documentation for this format

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Basic 0..*BasicResource for non-supported content
... meta
.... lastUpdated S1..1instantWhen the resource version last changed
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-FormularyReference-extension S1..1Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
... usdf-AvailabilityPeriod-extension S0..1PeriodAvailability Period
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension
... usdf-PharmacyBenefitType-extension S1..*CodeableConceptPharmacy Benefit Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension
Binding: Pharmacy benefit types (extensible)
... usdf-DrugTierID-extension S1..1CodeableConceptDrug 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 S0..1booleanPrior Authorization
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension
... usdf-PriorAuthorizationNewStartsOnly-extension 0..1booleanPrior Authorization New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension
... usdf-StepTherapyLimit-extension S0..1booleanStep Therapy Limit
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension
... usdf-StepTherapyLimitNewStartsOnly-extension 0..1booleanStep Therapy Limit New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension
... usdf-QuantityLimit-extension S0..1booleanQuantity 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..1markdownAdditional Coverage Information
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension
... code 1..1CodeableConceptKind of Resource
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: formulary-item
... subject S1..1Reference(Formulary Drug)Identifies the focus of this resource

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Basic 0..*BasicResource for non-supported content
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated SΣ1..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ0..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ0..*CodingTags 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 ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... usdf-FormularyReference-extension S1..1Reference(Formulary)Formulary Reference
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension
... usdf-AvailabilityStatus-extension S1..1codeAvailability Status
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension
Binding: PublicationStatus (required)
... usdf-AvailabilityPeriod-extension S0..1PeriodAvailability Period
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension
... usdf-PharmacyBenefitType-extension S1..*CodeableConceptPharmacy Benefit Type
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension
Binding: Pharmacy benefit types (extensible)
... usdf-DrugTierID-extension S1..1CodeableConceptDrug 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 S0..1booleanPrior Authorization
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension
... usdf-PriorAuthorizationNewStartsOnly-extension 0..1booleanPrior Authorization New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension
... usdf-StepTherapyLimit-extension S0..1booleanStep Therapy Limit
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension
... usdf-StepTherapyLimitNewStartsOnly-extension 0..1booleanStep Therapy Limit New Starts Only
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension
... usdf-QuantityLimit-extension S0..1booleanQuantity 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..1markdownAdditional Coverage Information
URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness identifier
... code ?!Σ1..1CodeableConceptKind of Resource
Binding: BasicResourceTypes (example): Codes for identifying types of resources not yet defined by FHIR.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: formulary-item
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(Formulary Drug)Identifies the focus of this resource
... created Σ0..1dateWhen created
... author Σ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)Who created

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
Basic.meta.securityextensibleAll Security Labels
Basic.meta.tagexampleCommonTags
Basic.languagepreferredCommonLanguages
Max Binding: AllLanguages
Basic.codeexamplePattern: formulary-item