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
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@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/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "usdf-DrugTierCS-TEMPORARY-TRIAL-USE"] ;
fhir:Resource.language [ fhir:value "en"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem usdf-DrugTierCS-TEMPORARY-TRIAL-USE</b></p><a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE\"> </a><a name=\"hcusdf-DrugTierCS-TEMPORARY-TRIAL-USE\"> </a><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<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-preferred\"> </a></td><td>Preferred</td><td>Commonly prescribed drugs that are preferred by the plan.</td></tr><tr><td style=\"white-space:nowrap\">non-preferred<a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-non-preferred\"> </a></td><td>Non-preferred</td><td>Commonly prescribed drugs that cost more than drugs in the 'preferred' 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>"
] ;
fhir:DomainResource.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:Extension.valueCode [ fhir:value "phx" ]
], [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:Extension.valueCode [
fhir:value "trial-use" ;
fhir:Element.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
fhir:Extension.valueCanonical [
fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary" ;
fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary>
]
]
]
] ;
fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"] ;
fhir:CodeSystem.identifier [
fhir:index -1 ;
fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ] ;
fhir:Identifier.value [ fhir:value "urn:oid:2.25.74595174031514506193398850787025340071.16.3" ]
] ;
fhir:CodeSystem.version [ fhir:value "2.1.0"] ;
fhir:CodeSystem.name [ fhir:value "DrugTierCS"] ;
fhir:CodeSystem.title [ fhir:value "Codes for medication drug tiers in health plans"] ;
fhir:CodeSystem.status [ fhir:value "active"] ;
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2026-08-03T19:19:34+00:00"^^xsd:dateTime] ;
fhir:CodeSystem.publisher [ fhir:value "HL7 International / Pharmacy"] ;
fhir:CodeSystem.contact [
fhir:index -1 ;
fhir:ContactDetail.name [ fhir:value "HL7 International / Pharmacy" ] ;
fhir:ContactDetail.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/medication" ]
], [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "email" ] ;
fhir:ContactPoint.value [ fhir:value "pharmacy@lists.HL7.org" ]
]
] ;
fhir:CodeSystem.description [ fhir: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."] ;
fhir:CodeSystem.jurisdiction [
fhir:index -1 ;
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
fhir:Coding.code [ fhir:value "US" ]
]
] ;
fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ;
fhir:CodeSystem.content [ fhir:value "complete"] ;
fhir:CodeSystem.count [ fhir:value "11"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "generic" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Generic" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Commonly prescribed generic drugs that cost more than drugs in the 'preferred generic' tier." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "preferred" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Preferred" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Commonly prescribed drugs that are preferred by the plan." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "non-preferred" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Non-preferred" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Commonly prescribed drugs that cost more than drugs in the 'preferred' tier." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "preferred-generic" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Preferred Generic" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Commonly prescribed generic drugs." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "non-preferred-generic" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Non-preferred Generic" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Generic drugs that cost more than drugs in ‘generic’ tier." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "specialty" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Specialty" ] ;
fhir:CodeSystem.concept.definition [ fhir: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." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "brand" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Brand" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Brand name drugs that cost more than ‘preferred brand’ drugs." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "preferred-brand" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Preferred Brand" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Brand name drugs" ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "non-preferred-brand" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Non-preferred Brand" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Brand name drugs that cost more than ‘brand’ drugs." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "zero-cost-share-preventative" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Zero cost-share preventative" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Preventive medications and products available at no cost." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "medical-service" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Medical Service" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit." ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE.ttl> .
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