DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU 3 (ci-build) United States of America flag

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 2.1.0 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

CodeSystem: Codes for medication drug tiers in health plans

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE Version: 2.1.0
Standards status: Trial-use Computable Name: DrugTierCS

Codes to represent the drug tier of a particular medication in a health plan. Base set are examples. Each plan may have its own controlled vocabulary.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE defines the following codes:

generic Generic Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.
preferred-generic Preferred Generic Commonly prescribed generic drugs.
non-preferred-generic Non-preferred Generic Generic drugs that cost more than drugs in ‘generic’ tier.
specialty Specialty 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.
brand Brand Brand name drugs that cost more than ‘preferred brand’ drugs.
preferred-brand Preferred Brand Brand name drugs
non-preferred-brand Non-preferred Brand Brand name drugs that cost more than ‘brand’ drugs.
zero-cost-share-preventative Zero cost-share preventative Preventive medications and products available at no cost.
medical-service Medical Service Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.