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 |
Generated Narrative: Basic FormularyItem-D1002-209459
Last updated: 2021-08-22 18:36:03+0000
Profile: Formulary Item
Formulary Reference: InsurancePlan Sample Medicare Advantage Part D Formulary D1002
Availability Status: active
Pharmacy Benefit Type: 3 month out of network retail
Drug Tier ID: Brand
Availability Period: 2021-01-01 --> 2021-12-31
Prior Authorization: true
Step Therapy Limit: false
Quantity Limit: false
code: Formulary Item
subject: MedicationKnowledge acetaminophen 500 MG Oral Tablet [Tylenol]