DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pdex-formulary/ and changes regularly. See the Directory of published versions
Page standards status: Informative |
Resource Basic "FormularyItem-D3004t-1049640" Updated "2021-08-22 18:36:03+0000"
Profile: Formulary Item
Formulary Reference: InsurancePlan/FormularyD3004t "Sample Medicare Advantage Part D Formulary D3004t"
Availability Status: active
Pharmacy Benefit Type: 3 month out of network retail (Codes for pharmacy benefit types#3-month-out-retail)
Drug Tier ID: Preferred Brand (Codes for medication drug tiers in health plans#preferred-brand)
Availability Period: 2021-01-01 --> 2021-12-31
Prior Authorization: true
Prior Authorization New Starts Only: true
Step Therapy Limit: true
Step Therapy Limit New Starts Only: false
Quantity Limit: true
code: Formulary Item (Codes for insurance item type#formulary-item)