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

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: Codes for medication drug tiers in health plans - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
  "text" : {
    "status" : "generated",
    "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><a name=\"usdf-DrugTierCS-TEMPORARY-TRIAL-USE-en-US\"> </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-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>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "phx"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
  "version" : "2.1.0",
  "name" : "DrugTierCS",
  "title" : "Codes for medication drug tiers in health plans",
  "status" : "active",
  "experimental" : false,
  "date" : "2024-09-24T20:29:11+00:00",
  "publisher" : "HL7 International / Pharmacy",
  "contact" : [
    {
      "name" : "HL7 International / Pharmacy",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/medication"
        },
        {
          "system" : "email",
          "value" : "pharmacy@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "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.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 9,
  "concept" : [
    {
      "code" : "generic",
      "display" : "Generic",
      "definition" : "Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier."
    },
    {
      "code" : "preferred-generic",
      "display" : "Preferred Generic",
      "definition" : "Commonly prescribed generic drugs."
    },
    {
      "code" : "non-preferred-generic",
      "display" : "Non-preferred Generic",
      "definition" : "Generic drugs that cost more than drugs in ‘generic’ tier."
    },
    {
      "code" : "specialty",
      "display" : "Specialty",
      "definition" : "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."
    },
    {
      "code" : "brand",
      "display" : "Brand",
      "definition" : "Brand name drugs that cost more than ‘preferred brand’ drugs."
    },
    {
      "code" : "preferred-brand",
      "display" : "Preferred Brand",
      "definition" : "Brand name drugs"
    },
    {
      "code" : "non-preferred-brand",
      "display" : "Non-preferred Brand",
      "definition" : "Brand name drugs that cost more than ‘brand’ drugs."
    },
    {
      "code" : "zero-cost-share-preventative",
      "display" : "Zero cost-share preventative",
      "definition" : "Preventive medications and products available at no cost."
    },
    {
      "code" : "medical-service",
      "display" : "Medical Service",
      "definition" : "Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit."
    }
  ]
}