DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU 3 (ci-build)
DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU 3 (ci-build)
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
| Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Formulary | Version: 2.1.0 | |||
| Standards status: Trial-use | Computable Name: Formulary | |||
The Formulary provides general information about a formulary and acts as an organizing construct that associated FormularyItem resources point to. The Formulary combined with its associated FormularyItem and FormularyDrug resources represent a formulary list that includes the set of drugs covered and the requirements and limitations of the coverage.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  InsurancePlan |
0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
  meta |
||||
  lastUpdated |
S | 1..1 | instant | When the resource version last changed |
 identifier |
S | 1..* | Identifier | Business Identifier for Product |
| status |
S | 1..1 | code | draft | active | retired | unknown |
| type |
S | 1..1 | CodeableConcept | Plan type Required Pattern: At least the following |
  coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
 system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name |
S | 0..1 | string | Official name |
| period |
S | 0..1 | Period | When the product is available |
| plan |
0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |
| type |
1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost |
0..* | BackboneElement | Pharmacy benefit type specific cost | |
| category |
1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |
| benefit |
0..* | BackboneElement | Drug tier benefit | |
| type |
1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVSfrom this IG | |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVSfrom this IG |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan |
C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one |
 meta |
Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
 lastUpdated |
SΣ | 1..1 | instant | When the resource version last changed ele-1: All FHIR elements must have a @value or children |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| identifier |
SΣC | 1..* | Identifier | Business Identifier for Product ele-1: All FHIR elements must have a @value or children |
| status |
?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children |
| type |
SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name |
SΣC | 0..1 | string | Official name ele-1: All FHIR elements must have a @value or children |
| period |
S | 0..1 | Period | When the product is available ele-1: All FHIR elements must have a @value or children |
| plan |
0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary ele-1: All FHIR elements must have a @value or children | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| type |
1..1 | CodeableConcept | Type of plan ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost |
0..* | BackboneElement | Pharmacy benefit type specific cost ele-1: All FHIR elements must have a @value or children | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| category |
1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) ele-1: All FHIR elements must have a @value or children | |
| benefit |
0..* | BackboneElement | Drug tier benefit ele-1: All FHIR elements must have a @value or children | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| type |
1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) ele-1: All FHIR elements must have a @value or children | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| InsurancePlan.status | required | PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | |
| InsurancePlan.type | example | Pattern: DRUGPOLhttp://hl7.org/fhir/ValueSet/insuranceplan-typefrom the FHIR Standard | |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVSfrom this IG | |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVSfrom this IG |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan |
C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one | ||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
 extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
SΣ | 1..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags 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 |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
SΣC | 1..* | Identifier | Business Identifier for Product | ||||
| status |
?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type |
SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| name |
SΣC | 0..1 | string | Official name | ||||
| alias |
0..* | string | Alternate names | |||||
| period |
S | 0..1 | Period | When the product is available | ||||
 ownedBy |
Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy |
Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea |
Σ | 0..* | Reference(Location) | Where product applies | ||||
| contact |
0..* | BackboneElement | Contact for the product | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose |
0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | |||||
| name |
0..1 | HumanName | A name associated with the contact | |||||
| telecom |
0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||
| address |
0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint |
0..* | Reference(Endpoint) | Technical endpoint | |||||
| network |
0..* | Reference(Organization) | What networks are Included | |||||
| coverage |
0..* | BackboneElement | Coverage details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of coverage | |||||
| network |
0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit |
1..* | BackboneElement | List of benefits | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of benefit | |||||
| requirement |
0..1 | string | Referral requirements | |||||
| limit |
0..* | BackboneElement | Benefit limits | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value |
0..1 | Quantity | Maximum value allowed | |||||
| code |
0..1 | CodeableConcept | Benefit limit details | |||||
| plan |
0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier |
Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type |
1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| coverageArea |
Σ | 0..* | Reference(Location) | Where product applies | ||||
| network |
0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost |
0..* | BackboneElement | Overall costs | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
0..1 | CodeableConcept | Type of cost | |||||
| groupSize |
0..1 | positiveInt | Number of enrollees | |||||
| cost |
0..1 | Money | Cost value | |||||
| comment |
0..1 | string | Additional cost information | |||||
| specificCost |
0..* | BackboneElement | Pharmacy benefit type specific cost | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category |
1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |||||
| benefit |
0..* | BackboneElement | Drug tier benefit | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |||||
| cost |
0..* | BackboneElement | List of the costs | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of cost | |||||
| applicability |
0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers |
0..* | CodeableConcept | Additional information about the cost | |||||
| value |
0..1 | Quantity | The actual cost value | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| InsurancePlan.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labelsfrom the FHIR Standard | ||||
| InsurancePlan.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsfrom the FHIR Standard | ||||
| InsurancePlan.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| InsurancePlan.status | required | PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | ||||
| InsurancePlan.type | example | Pattern: DRUGPOLhttp://hl7.org/fhir/ValueSet/insuranceplan-typefrom the FHIR Standard | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityTypehttp://hl7.org/fhir/ValueSet/contactentity-typefrom the FHIR Standard | ||||
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVSfrom this IG | ||||
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVSfrom this IG | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1from the FHIR Standard |
This structure is derived from InsurancePlan
Differential View
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan |
0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
| meta |
||||
| lastUpdated |
S | 1..1 | instant | When the resource version last changed |
| identifier |
S | 1..* | Identifier | Business Identifier for Product |
| status |
S | 1..1 | code | draft | active | retired | unknown |
| type |
S | 1..1 | CodeableConcept | Plan type Required Pattern: At least the following |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name |
S | 0..1 | string | Official name |
| period |
S | 0..1 | Period | When the product is available |
| plan |
0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |
| type |
1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost |
0..* | BackboneElement | Pharmacy benefit type specific cost | |
| category |
1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |
| benefit |
0..* | BackboneElement | Drug tier benefit | |
| type |
1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVSfrom this IG | |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVSfrom this IG |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan |
C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one |
| meta |
Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
| lastUpdated |
SΣ | 1..1 | instant | When the resource version last changed ele-1: All FHIR elements must have a @value or children |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| identifier |
SΣC | 1..* | Identifier | Business Identifier for Product ele-1: All FHIR elements must have a @value or children |
| status |
?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children |
| type |
SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| name |
SΣC | 0..1 | string | Official name ele-1: All FHIR elements must have a @value or children |
| period |
S | 0..1 | Period | When the product is available ele-1: All FHIR elements must have a @value or children |
| plan |
0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary ele-1: All FHIR elements must have a @value or children | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| type |
1..1 | CodeableConcept | Type of plan ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Drug | |
| specificCost |
0..* | BackboneElement | Pharmacy benefit type specific cost ele-1: All FHIR elements must have a @value or children | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| category |
1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) ele-1: All FHIR elements must have a @value or children | |
| benefit |
0..* | BackboneElement | Drug tier benefit ele-1: All FHIR elements must have a @value or children | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| type |
1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) ele-1: All FHIR elements must have a @value or children | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| InsurancePlan.status | required | PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | |
| InsurancePlan.type | example | Pattern: DRUGPOLhttp://hl7.org/fhir/ValueSet/insuranceplan-typefrom the FHIR Standard | |
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVSfrom this IG | |
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVSfrom this IG |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan |
C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one | ||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
SΣ | 1..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags 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 |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
SΣC | 1..* | Identifier | Business Identifier for Product | ||||
| status |
?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type |
SΣ | 1..1 | CodeableConcept | Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| name |
SΣC | 0..1 | string | Official name | ||||
| alias |
0..* | string | Alternate names | |||||
| period |
S | 0..1 | Period | When the product is available | ||||
| ownedBy |
Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy |
Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea |
Σ | 0..* | Reference(Location) | Where product applies | ||||
| contact |
0..* | BackboneElement | Contact for the product | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose |
0..1 | CodeableConcept | The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party. | |||||
| name |
0..1 | HumanName | A name associated with the contact | |||||
| telecom |
0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | |||||
| address |
0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint |
0..* | Reference(Endpoint) | Technical endpoint | |||||
| network |
0..* | Reference(Organization) | What networks are Included | |||||
| coverage |
0..* | BackboneElement | Coverage details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of coverage | |||||
| network |
0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit |
1..* | BackboneElement | List of benefits | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of benefit | |||||
| requirement |
0..1 | string | Referral requirements | |||||
| limit |
0..* | BackboneElement | Benefit limits | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value |
0..1 | Quantity | Maximum value allowed | |||||
| code |
0..1 | CodeableConcept | Benefit limit details | |||||
| plan |
0..1 | BackboneElement | Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier |
Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type |
1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| coverageArea |
Σ | 0..* | Reference(Location) | Where product applies | ||||
| network |
0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost |
0..* | BackboneElement | Overall costs | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
0..1 | CodeableConcept | Type of cost | |||||
| groupSize |
0..1 | positiveInt | Number of enrollees | |||||
| cost |
0..1 | Money | Cost value | |||||
| comment |
0..1 | string | Additional cost information | |||||
| specificCost |
0..* | BackboneElement | Pharmacy benefit type specific cost | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category |
1..1 | CodeableConcept | General category of benefit Binding: Pharmacy benefit types (extensible) | |||||
| benefit |
0..* | BackboneElement | Drug tier benefit | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | |||||
| cost |
0..* | BackboneElement | List of the costs | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type |
1..1 | CodeableConcept | Type of cost | |||||
| applicability |
0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers |
0..* | CodeableConcept | Additional information about the cost | |||||
| value |
0..1 | Quantity | The actual cost value | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| InsurancePlan.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labelsfrom the FHIR Standard | ||||
| InsurancePlan.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsfrom the FHIR Standard | ||||
| InsurancePlan.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| InsurancePlan.status | required | PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | ||||
| InsurancePlan.type | example | Pattern: DRUGPOLhttp://hl7.org/fhir/ValueSet/insuranceplan-typefrom the FHIR Standard | ||||
| InsurancePlan.contact.purpose | extensible | ContactEntityTypehttp://hl7.org/fhir/ValueSet/contactentity-typefrom the FHIR Standard | ||||
| InsurancePlan.plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVSfrom this IG | ||||
| InsurancePlan.plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans)http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVSfrom this IG | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicabilityhttp://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1from the FHIR Standard |
This structure is derived from InsurancePlan
Other representations of profile: CSV, Excel, Schematron
IG © 2022+ HL7 International / Pharmacy. Package hl7.fhir.us.davinci-drug-formulary#2.1.0 based on FHIR 4.0.1. Generated 2024-12-16
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