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

: Codes for medication drug tiers in health plans - XML Representation

Page standards status: Trial-use

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="usdf-DrugTierCS-TEMPORARY-TRIAL-USE"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">generic<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-generic"> </a></td><td>Generic</td><td>Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.</td></tr><tr><td style="white-space:nowrap">preferred-generic<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-preferred-generic"> </a></td><td>Preferred Generic</td><td>Commonly prescribed generic drugs.</td></tr><tr><td style="white-space:nowrap">non-preferred-generic<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-non-preferred-generic"> </a></td><td>Non-preferred Generic</td><td>Generic drugs that cost more than drugs in ‘generic’ tier.</td></tr><tr><td style="white-space:nowrap">specialty<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-specialty"> </a></td><td>Specialty</td><td>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.</td></tr><tr><td style="white-space:nowrap">brand<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-brand"> </a></td><td>Brand</td><td>Brand name drugs that cost more than ‘preferred brand’ drugs.</td></tr><tr><td style="white-space:nowrap">preferred-brand<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-preferred-brand"> </a></td><td>Preferred Brand</td><td>Brand name drugs</td></tr><tr><td style="white-space:nowrap">non-preferred-brand<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-non-preferred-brand"> </a></td><td>Non-preferred Brand</td><td>Brand name drugs that cost more than ‘brand’ drugs.</td></tr><tr><td style="white-space:nowrap">zero-cost-share-preventative<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-zero-cost-share-preventative"> </a></td><td>Zero cost-share preventative</td><td>Preventive medications and products available at no cost.</td></tr><tr><td style="white-space:nowrap">medical-service<a name="usdf-DrugTierCS-TEMPORARY-TRIAL-USE-medical-service"> </a></td><td>Medical Service</td><td>Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="phx"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"/>
  <version value="2.1.0"/>
  <name value="DrugTierCS"/>
  <title value="Codes for medication drug tiers in health plans"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-06-06T20:54:07+00:00"/>
  <publisher value="HL7 International / Pharmacy"/>
  <contact>
    <name value="HL7 International / Pharmacy"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/medication"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pharmacy@lists.HL7.org"/>
    </telecom>
  </contact>
  <description
               value="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."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="9"/>
  <concept>
    <code value="generic"/>
    <display value="Generic"/>
    <definition
                value="Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier."/>
  </concept>
  <concept>
    <code value="preferred-generic"/>
    <display value="Preferred Generic"/>
    <definition value="Commonly prescribed generic drugs."/>
  </concept>
  <concept>
    <code value="non-preferred-generic"/>
    <display value="Non-preferred Generic"/>
    <definition
                value="Generic drugs that cost more than drugs in ‘generic’ tier."/>
  </concept>
  <concept>
    <code value="specialty"/>
    <display value="Specialty"/>
    <definition
                value="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."/>
  </concept>
  <concept>
    <code value="brand"/>
    <display value="Brand"/>
    <definition
                value="Brand name drugs that cost more than ‘preferred brand’ drugs."/>
  </concept>
  <concept>
    <code value="preferred-brand"/>
    <display value="Preferred Brand"/>
    <definition value="Brand name drugs"/>
  </concept>
  <concept>
    <code value="non-preferred-brand"/>
    <display value="Non-preferred Brand"/>
    <definition value="Brand name drugs that cost more than ‘brand’ drugs."/>
  </concept>
  <concept>
    <code value="zero-cost-share-preventative"/>
    <display value="Zero cost-share preventative"/>
    <definition
                value="Preventive medications and products available at no cost."/>
  </concept>
  <concept>
    <code value="medical-service"/>
    <display value="Medical Service"/>
    <definition
                value="Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit."/>
  </concept>
</CodeSystem>