DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1
DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1
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
| Page standards status: Informative |
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/InsurancePlan/PayerInsurancePlanA1002> a fhir:InsurancePlan ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "PayerInsurancePlanA1002"] ;
fhir:Resource.meta [
fhir:Meta.lastUpdated [ fhir:value "2021-08-22T18:36:03.000+00:00"^^xsd:dateTime ] ;
fhir:Meta.profile [
fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan" ;
fhir:index -1 ;
fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan>
]
] ;
fhir:Resource.language [ fhir:value "en"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "extensions" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: InsurancePlan PayerInsurancePlanA1002</b></p><a name=\"PayerInsurancePlanA1002\"> </a><a name=\"hcPayerInsurancePlanA1002\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2021-08-22 18:36:03+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-usdf-PayerInsurancePlan.html\">Payer Insurance Plan</a></p></div><p><b>identifier</b>: A1002</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS mediadv}\">Medicare Advantage</span></p><p><b>name</b>: Sample Medicare Advantage Plan A1002</p><p><b>period</b>: 2021-01-01 --> 2021-12-31</p><p><b>coverageArea</b>: <a href=\"Location-StateOfCTLocation.html\">Location State of CT Area</a></p><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/contactentity-type PATINF}\">Patient</span></p><p><b>telecom</b>: <a href=\"tel:+1(888)555-1002\">+1 (888) 555-1002</a></p></blockquote><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE MARKETING}\">Marketting</span></p><p><b>name</b>: Sample Medicare Advantage Plan Marketing Website</p><p><b>telecom</b>: <a href=\"http://url/to/health/plan/information\">http://url/to/health/plan/information</a></p></blockquote><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE SUMMARY}\">Summary</span></p><p><b>name</b>: Sample Medicare Advantage Drug Plan Benefit Website</p><p><b>telecom</b>: <a href=\"http://url/to/health/plan/information\">http://url/to/health/plan/information</a></p></blockquote><blockquote><p><b>contact</b></p><p><b>purpose</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE FORMULARY}\">Formulary</span></p><p><b>name</b>: Sample Medicare Advantage Drug Plan Formulary Website</p><p><b>telecom</b>: <a href=\"http://url/to/health/plan/information\">http://url/to/health/plan/information</a></p></blockquote><blockquote><p><b>coverage</b></p><p><b>Formulary Reference</b>: <a href=\"InsurancePlan-FormularyD1002.html\">InsurancePlan Sample Medicare Advantage Part D Formulary D1002</a></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode DRUGPOL}\">drug policy</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/insurance-plan-type drug}\">Drug</span></td></tr></table></blockquote><blockquote><p><b>plan</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/insurance-plan-type drug}\">Drug</span></p><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE 1-month-in-retail}\">1 month in network retail</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE brand}\">Brand</span></p><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE copay}\">Copay</span></p><p><b>qualifiers</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE after-deductible}\">After Deductible</span></p><p><b>value</b>: 20 $<span style=\"background: LightGoldenRodYellow\"> (Details: unknown codeUSD = 'United States dollar')</span></p></blockquote><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE coinsurance}\">Coinsurance</span></p><p><b>qualifiers</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE after-deductible}\">After Deductible</span></p><p><b>value</b>: 20 %<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM code% = '%')</span></p></blockquote></blockquote></blockquote></blockquote></div>"
] ;
fhir:InsurancePlan.identifier [
fhir:index -1 ;
fhir:Identifier.value [ fhir:value "A1002" ]
] ;
fhir:InsurancePlan.status [ fhir:value "active"] ;
fhir:InsurancePlan.type [
fhir:index -1 ;
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS" ] ;
fhir:Coding.code [ fhir:value "mediadv" ]
]
] ;
fhir:InsurancePlan.name [ fhir:value "Sample Medicare Advantage Plan A1002"] ;
fhir:InsurancePlan.period [
fhir:Period.start [ fhir:value "2021-01-01"^^xsd:date ] ;
fhir:Period.end [ fhir:value "2021-12-31"^^xsd:date ]
] ;
fhir:InsurancePlan.coverageArea [
fhir:index -1 ;
fhir:link <http://hl7.org/fhir/Location/StateOfCTLocation> ;
fhir:Reference.reference [ fhir:value "Location/StateOfCTLocation" ]
] ;
fhir:InsurancePlan.contact [
fhir:index -1 ;
fhir:InsurancePlan.contact.purpose [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/contactentity-type" ] ;
fhir:Coding.code [ fhir:value "PATINF" ]
]
] ;
fhir:InsurancePlan.contact.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "phone" ] ;
fhir:ContactPoint.value [ fhir:value "+1 (888) 555-1002" ]
]
], [
fhir:index -1 ;
fhir:InsurancePlan.contact.purpose [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "MARKETING" ]
]
] ;
fhir:InsurancePlan.contact.name [
fhir:HumanName.text [ fhir:value "Sample Medicare Advantage Plan Marketing Website" ]
] ;
fhir:InsurancePlan.contact.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://url/to/health/plan/information" ]
]
], [
fhir:index -1 ;
fhir:InsurancePlan.contact.purpose [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "SUMMARY" ]
]
] ;
fhir:InsurancePlan.contact.name [
fhir:HumanName.text [ fhir:value "Sample Medicare Advantage Drug Plan Benefit Website" ]
] ;
fhir:InsurancePlan.contact.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://url/to/health/plan/information" ]
]
], [
fhir:index -1 ;
fhir:InsurancePlan.contact.purpose [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "FORMULARY" ]
]
] ;
fhir:InsurancePlan.contact.name [
fhir:HumanName.text [ fhir:value "Sample Medicare Advantage Drug Plan Formulary Website" ]
] ;
fhir:InsurancePlan.contact.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://url/to/health/plan/information" ]
]
] ;
fhir:InsurancePlan.coverage [
fhir:index -1 ;
fhir:Element.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension" ] ;
fhir:Extension.valueReference [
fhir:link <http://hl7.org/fhir/InsurancePlan/FormularyD1002> ;
fhir:Reference.reference [ fhir:value "InsurancePlan/FormularyD1002" ]
]
] ;
fhir:InsurancePlan.coverage.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ] ;
fhir:Coding.code [ fhir:value "DRUGPOL" ]
]
] ;
fhir:InsurancePlan.coverage.benefit [
fhir:index -1 ;
fhir:InsurancePlan.coverage.benefit.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/insurance-plan-type" ] ;
fhir:Coding.code [ fhir:value "drug" ] ;
fhir:Coding.display [ fhir:value "Drug" ]
]
]
]
] ;
fhir:InsurancePlan.plan [
fhir:index -1 ;
fhir:InsurancePlan.plan.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/insurance-plan-type" ] ;
fhir:Coding.code [ fhir:value "drug" ] ;
fhir:Coding.display [ fhir:value "Drug" ]
]
] ;
fhir:InsurancePlan.plan.specificCost [
fhir:index -1 ;
fhir:InsurancePlan.plan.specificCost.category [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "1-month-in-retail" ] ;
fhir:Coding.display [ fhir:value "1 month in network retail" ]
]
] ;
fhir:InsurancePlan.plan.specificCost.benefit [
fhir:index -1 ;
fhir:InsurancePlan.plan.specificCost.benefit.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "brand" ] ;
fhir:Coding.display [ fhir:value "Brand" ]
]
] ;
fhir:InsurancePlan.plan.specificCost.benefit.cost [
fhir:index -1 ;
fhir:InsurancePlan.plan.specificCost.benefit.cost.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "copay" ] ;
fhir:Coding.display [ fhir:value "Copay" ]
]
] ;
fhir:InsurancePlan.plan.specificCost.benefit.cost.qualifiers [
fhir:index -1 ;
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "after-deductible" ] ;
fhir:Coding.display [ fhir:value "After Deductible" ]
]
] ;
fhir:InsurancePlan.plan.specificCost.benefit.cost.value [
fhir:Quantity.value [ fhir:value "20"^^xsd:decimal ] ;
fhir:Quantity.unit [ fhir:value "$" ] ;
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ] ;
fhir:Quantity.code [ fhir:value "USD" ]
]
], [
fhir:index -1 ;
fhir:InsurancePlan.plan.specificCost.benefit.cost.type [
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "coinsurance" ] ;
fhir:Coding.display [ fhir:value "Coinsurance" ]
]
] ;
fhir:InsurancePlan.plan.specificCost.benefit.cost.qualifiers [
fhir:index -1 ;
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE" ] ;
fhir:Coding.code [ fhir:value "after-deductible" ] ;
fhir:Coding.display [ fhir:value "After Deductible" ]
]
] ;
fhir:InsurancePlan.plan.specificCost.benefit.cost.value [
fhir:Quantity.value [ fhir:value "20"^^xsd:decimal ] ;
fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ] ;
fhir:Quantity.code [ fhir:value "%" ]
]
]
]
]
] .
<http://hl7.org/fhir/Location/StateOfCTLocation> a fhir:Location .
<http://hl7.org/fhir/InsurancePlan/FormularyD1002> a fhir:InsurancePlan .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/InsurancePlan/PayerInsurancePlanA1002.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/InsurancePlan/PayerInsurancePlanA1002.ttl> .
IG © 2025+ HL7 International / Pharmacy.
Package hl7.fhir.us.davinci-drug-formulary#2.1.0 based on FHIR 4.0.1.
Generated
2026-08-03
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change