DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2 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 2.0.1 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

Change Notes

Page standards status: Informative

Changes and Updates for Version 2.0.1

The current official published version of Da Vinci Payer Data Exchange (PDex) US Drug Formulary for FHIR R4 (STU Technical Correction of STU 2)

The following issues are addressed in this release:

Changes and Updates for Version 2.0.0

Da Vinci Payer Data Exchange (PDex) US Drug Formulary for FHIR R4 (STU 2)

The following issues are addressed in this release:

<!– The Following are only changes from the ballot version and final published version FHIR-34756 - Improve the name of value set “Type of pharmacies” FHIR-35366 - Simplify FormularyItem by inlining drug codes


Changes and Updates for Version 1.1.0

Da Vinci Payer Data Exchange (PDex) US Drug Formulary for FHIR R4 (STU Update of STU 1)

The following issues are addressed in this release:

  • FHIR-28293:

    Changed the PlanID extension description to from:

    “Unique, 14-character, HIOS-generated Plan ID number (Plan IDs must be unique, even across different markets.)”


    “Unique, generated Plan ID number, such as HIOS ID for QHPs or Contract Number for Medicare Advantage Plans. Plan IDs must be unique within each organization that manages their formulary data.”

  • FHIR-29965:

    Added guidance that CoveragePlan.MarketingURL, CoveragePlan.SummaryURL, and CoveragePlan.FormularyURL can point to a page providing links for multiple language options.

  • FHIR-30412:

    Changed the type of CoveragePlan.MarketingURL, CoveragePlan.SummaryURL, and CoveragePlan.FormularyURL extensions from a String value to a URL value.

  • FHIR-30924:

    Added "Not applicable" to the usdf-CopayOptionCS code system. Zero-deductible cost sharing is represented by a co-pay value of "Not applicable" and a co-insurance value of "No charge", consistent with updated QHP guidelines.

  • FHIR-30925:

    Added an optional boolean MailOrder extension to FormularyDrug profile. The MailOrder value in FormularyDrug overrides the MailOrder value in the DrugTierDefinition extension for CoveragePlan.

  • FHIR-30933:

    Changed the type of EmailPlanContact extension from String to URL. We also added narrative to EmailPlanContact that a FHIR URL type can be a web-url or an email address.

  • FHIR-31031:

    Since _profile search parameter is not required for anticipated client queries, we removed the "_profile" search parameter for the Medication Knowledge and List resource examples.

  • FHIR-31037:

    The CoveragePlan PlanIDType extension was not defined for non-HIOS plans so we included narrative in Plan ID Type, to include "For all other plans this should be: OTHER-PLAN-ID as part of the definition.

  • FHIR-31073:

    Added guidance for behavior for authenticated member access, when the member has already selected a plan or not, when they belong to a plan group or not.

  • FHIR-31591:

    Changed the code display in Formulary Drug cmspi9, to "doxepin hydrochloride 50 MG/ML Topical Cream" to match the given code of #1000091.

  • FHIR-31672:

    Added guidance to enter "Not applicable" in the Network extension for a CoveragePlan that has no applicable network associated with it.

  • FHIR-31683:

    We changed List.code to be set to the code DRUGPOL and changed the cardinality to 1..1 in the Formulary Coverage Plan. Additionally, in Anticipated Client Queries the queries that reference list now reference the DRUGPOL code.

  • FHIR-31684:

    Guidance was added to Additional Guidance regarding searching for FormularyDrugs with know PlanIDs and without.

  • FHIR-31762:

    Updated search parameter descriptions to include all of the search parameters in the CapabilityStatement.

  • FHIR-32178:

    Added "charge" to the usdf-CopayOptionCS and the usdf-CoinsuranceOptionCScode systems to handle drugs that consist of a charge, but are not subject to a deductible.

  • FHIR-32622:

    Guidance was added to Formulary Coverage Plan indicating that we are considering basing the CoveragePlan profile off of the InsurancePlan resource in a future release instead of the List resource.

  • FHIR-32625:

    Changes were implemented to improve the navigation by updating the Table of Contents, the specification menu, and page design.

  • FHIR-32627:

    Guidance was added to Search Parameters indicating that the search parameters DrugName, DrugPlan, and DrugTier will be changed to more compliant names like: lower-case 'drug-name', 'drug-plan', and 'drug-tier' in a future release.

  • FHIR-32723:

    Several value sets found in Terminology: Code Systems were not properly displaying the value and description correctly for "code for qualifier for coinsurance rate", "codes for qualifier of copay amount" and "codes for medication drug tiers in health plans". This has been corrected. The definition column has been updated to no longer be blank and contain the proper information.

  • FHIR-32958:

    Added guidance for searching by drug name strings.

  • FHIR-32958:

    Added guidance on drug name searching with description of RxNorm term types, formats, and drug names that might appear on a formulary.