DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.0 - STU 2 United States of America flag

DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 Pharmacy Working Group. This is not an authorized publication; it is the continuous build for version 2.0.0). 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

Resource Profile: FormularyItem - Detailed Descriptions

Active as of 2022-08-25

Definitions for the usdf-FormularyItem resource profile.

1. Basic
Definition

Basic is used for handling concepts not yet defined in FHIR, narrative-only resources that don't map to an existing resource, and custom resources not appropriate for inclusion in the FHIR specification.

Control0..*
Alternate NamesZ-resource, Extension-resource, Custom-resource
InvariantsDefined on this element
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.`div`.exists())
2. Basic.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typestring
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. Basic.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Control0..1
TypeMeta
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. Basic.meta.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
5. Basic.meta.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Basic.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
6. Basic.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

Control0..1
Typeid
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. Basic.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

Control1..1
Typeinstant
Must Supporttrue
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
8. Basic.meta.source
Definition

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

Control0..1
Typeuri
Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
9. Basic.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Control0..*
Typecanonical(StructureDefinition)
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
10. Basic.meta.security
Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Control0..*
BindingThe codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable Security Labels from the Healthcare Privacy and Security Classification System.

TypeCoding
Comments

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. Basic.meta.tag
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..*
BindingFor example codes, see CommonTags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

TypeCoding
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
12. Basic.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. Basic.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. Basic.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. Basic.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

16. Basic.extension
Definition

An Extension

Control4..*
TypeExtension
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Basic.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
17. Basic.extension:usdf-FormularyReference-extension
SliceNameusdf-FormularyReference-extension
Definition

Reference to the formulary this item belongs to.

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(FormularyReference) (Extension Type: Reference)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
18. Basic.extension:usdf-AvailabilityStatus-extension
SliceNameusdf-AvailabilityStatus-extension
Definition

A boolean indicating whether the formulary item is currently available under the formulary. Drugs may appear on a formulary, but not considered "active" for the current year. Drugs may also be removed during the course of a plan year.

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(AvailabilityStatus) (Extension Type: code)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
19. Basic.extension:usdf-AvailabilityPeriod-extension
SliceNameusdf-AvailabilityPeriod-extension
Definition

The period for which this item is available on the formulary. Drugs may appear on a formulary, but not considered "active" for the current year.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(AvailabilityPeriod) (Extension Type: Period)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
20. Basic.extension:usdf-PharmacyBenefitType-extension
SliceNameusdf-PharmacyBenefitType-extension
Definition

A CodeableConcept indicating the pharmacy benefit type the formulary drug is available through the associated plan. This pharmacy benefit type is specific to the FormularyDrug and indicates which of the pharmacy benefit type from the plan applies to the particular formulary drug.

Control1..* This element is affected by the following invariants: ele-1
TypeExtension(PharmacyBenefitType) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
21. Basic.extension:usdf-DrugTierID-extension
SliceNameusdf-DrugTierID-extension
Definition

A code that describes the coverage status of a drug in a health plan (e.g., preferred generic, specialty, etc.)

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(DrugTierID) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
22. Basic.extension:usdf-PriorAuthorization-extension
SliceNameusdf-PriorAuthorization-extension
Definition

A Boolean indication of whether the coverage plan imposes a prior authorization requirement on this drug.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(PriorAuthorization) (Extension Type: boolean)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
23. Basic.extension:usdf-PriorAuthorizationNewStartsOnly-extension
SliceNameusdf-PriorAuthorizationNewStartsOnly-extension
Definition

A Boolean indication of whether the coverage plan imposes a prior authorization requirement on this drug for new starts only. (Only include if PriorAuthorization = true)

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(PriorAuthorizationNewStartsOnly) (Extension Type: boolean)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
24. Basic.extension:usdf-StepTherapyLimit-extension
SliceNameusdf-StepTherapyLimit-extension
Definition

A boolean indicating whether the coverage plan imposes a step therapy requirement on this drug meaning another drug may need to be tried beforehand.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(StepTherapyLimit) (Extension Type: boolean)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
25. Basic.extension:usdf-StepTherapyLimitNewStartsOnly-extension
SliceNameusdf-StepTherapyLimitNewStartsOnly-extension
Definition

A boolean indicating whether the coverage plan imposes a step therapy requirement on this drug meaning another drug may need to be tried beforehand for new starts only (Not required if patient has previously met step therapy requirements). (Only include if StepTherapyLimit = true)

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(StepTherapyLimitNewStartsOnly) (Extension Type: boolean)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
26. Basic.extension:usdf-QuantityLimit-extension
SliceNameusdf-QuantityLimit-extension
Definition

A Boolean indication of whether the coverage plan imposes a quantity limit on this drug.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(QuantityLimit) (Extension Type: boolean)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
27. Basic.extension:usdf-QuantityLimitDetail-extension
SliceNameusdf-QuantityLimitDetail-extension
Definition

A detailed definition of the quantity limits the coverage plan imposes on this drug. These limit details may include (potentially including a rolling dispense limit, maximum daily, or therapy days for a period of time. (Only include if QuantityLimit = true)

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(QuantityLimitDetail) (Complex Extension)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
28. Basic.extension:usdf-AdditionalCoverageInformation-extension
SliceNameusdf-AdditionalCoverageInformation-extension
Definition

Additional drug coverage information that may include conditional coverage requirements such as a diagnosis pre-requisite, additional drug specific cost sharing information, or other coverage details not otherwise indicated.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(AdditionalCoverageInformation) (Extension Type: markdown)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
29. Basic.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
30. Basic.identifier
Definition

Identifier assigned to the resource for business purposes, outside the context of FHIR.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. Basic.code
Definition

Identifies the 'type' of resource - equivalent to the resource name for other resources.

Control1..1
BindingFor example codes, see BasicResourceTypes Codes for identifying types of resources not yet defined by FHIR.

TypeCodeableConcept
Is Modifiertrue
Requirements

Must be able to distinguish different types of Basic resources.

Comments

Because resource references will only be able to indicate 'Basic', the type of reference will need to be specified in a Profile identified as part of the resource. Refer to the resource notes section for information on appropriate terminologies for this code.

This element is labeled as a modifier because it defines the meaning of the resource and cannot be ignored.

Pattern Value<valueCodeableConcept xmlns="http://hl7.org/fhir">
  <coding>
    <system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS"/>
    <code value="formulary-item"/>
  </coding>
</valueCodeableConcept>
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. Basic.subject
Definition

Identifies the patient, practitioner, device or any other resource that is the "focus" of this resource.

Control1..1
TypeReference(FormularyDrug)
Must Supporttrue
Requirements

Needed for partitioning the resource by Patient.

Comments

Optional as not all potential resources will have subjects. Resources associated with multiple subjects can handle this via extension.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
33. Basic.created
Definition

Identifies when the resource was first created.

Control0..1
Typedate
Requirements

Allows ordering resource instances by time.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. Basic.author
Definition

Indicates who was responsible for creating the resource instance.

Control0..1
TypeReference(Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)
Requirements

Needed for partitioning the resource.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))