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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: Formulary

The Formulary provides general information about a formulary and acts as an organizing construct that associated FormularyItem resources point to. The Formulary combined with its associated FormularyItem and FormularyDrug resources represent a formulary list that includes the set of drugs covered and the requirements and limitations of the coverage.

Usage:

• Refer to this Resource Profile: Formulary Reference
• Examples for this Resource Profile: Sample Medicare Advantage Part D Formulary D1002, Sample Medicare Advantage Part D Formulary D3001, Sample Medicare Advantage Part D Formulary D3002 and Sample Medicare Advantage Part D Formulary D3004t
• CapabilityStatements using this Resource Profile: usdf-server CapabilityStatement

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
lastUpdated	SΣ	1..1	instant	When the resource version last changed ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣC	1..*	Identifier	Business Identifier for Product ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: DRUGPOL
name	SΣC	0..1	string	Official name ele-1: All FHIR elements must have a @value or children
period	S	0..1	Period	When the product is available ele-1: All FHIR elements must have a @value or children
plan		0..1	BackboneElement	Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Type of plan ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drug
display		1..1	string	Representation defined by the system Fixed Value: Drug
specificCost		0..*	BackboneElement	Pharmacy benefit type specific cost ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category		1..1	CodeableConcept	General category of benefit Binding: Pharmacy benefit types (extensible) ele-1: All FHIR elements must have a @value or children
benefit		0..*	BackboneElement	Drug tier benefit ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Type of specific benefit Binding: Drug tier of medication in health plan (extensible) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	example	Pattern: DRUGPOL http://hl7.org/fhir/ValueSet/insuranceplan-type from the FHIR Standard
InsurancePlan.plan.specificCost.category	extensible	PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS from this IG
InsurancePlan.plan.specificCost.benefit.type	extensible	DrugTierVS (a valid code from Codes for medication drug tiers in health plans) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS from this IG

This structure is derived from InsurancePlan

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan		0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization
meta
lastUpdated	S	1..1	instant	When the resource version last changed
identifier	S	1..*	Identifier	Business Identifier for Product
status	S	1..1	code	draft | active | retired | unknown
type	S	1..1	CodeableConcept	Plan type Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: DRUGPOL
name	S	0..1	string	Official name
period	S	0..1	Period	When the product is available
plan		0..1	BackboneElement	Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary
type		1..1	CodeableConcept	Type of plan Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drug
display		1..1	string	Representation defined by the system Fixed Value: Drug
specificCost		0..*	BackboneElement	Pharmacy benefit type specific cost
category		1..1	CodeableConcept	General category of benefit Binding: Pharmacy benefit types (extensible)
benefit		0..*	BackboneElement	Drug tier benefit
type		1..1	CodeableConcept	Type of specific benefit Binding: Drug tier of medication in health plan (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
InsurancePlan.plan.specificCost.category	extensible	PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS from this IG
InsurancePlan.plan.specificCost.benefit.type	extensible	DrugTierVS (a valid code from Codes for medication drug tiers in health plans) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS from this IG

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	Business Identifier for Product
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
type	SΣ	1..1	CodeableConcept	Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: DRUGPOL
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
name	SΣC	0..1	string	Official name
alias		0..*	string	Alternate names
period	S	0..1	Period	When the product is available
ownedBy	Σ	0..1	Reference(Organization)	Plan issuer
administeredBy	Σ	0..1	Reference(Organization)	Product administrator
coverageArea	Σ	0..*	Reference(Location)	Where product applies
contact		0..*	BackboneElement	Contact for the product
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose		0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
name		0..1	HumanName	A name associated with the contact
telecom		0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
address		0..1	Address	Visiting or postal addresses for the contact
endpoint		0..*	Reference(Endpoint)	Technical endpoint
network		0..*	Reference(Organization)	What networks are Included
coverage		0..*	BackboneElement	Coverage details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of coverage
network		0..*	Reference(Organization)	What networks provide coverage
benefit		1..*	BackboneElement	List of benefits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of benefit
requirement		0..1	string	Referral requirements
limit		0..*	BackboneElement	Benefit limits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	Quantity	Maximum value allowed
code		0..1	CodeableConcept	Benefit limit details
plan		0..1	BackboneElement	Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier	Σ	0..*	Identifier	Business Identifier for Product
type		1..1	CodeableConcept	Type of plan Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drug
display		1..1	string	Representation defined by the system Fixed Value: Drug
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coverageArea	Σ	0..*	Reference(Location)	Where product applies
network		0..*	Reference(Organization)	What networks provide coverage
generalCost		0..*	BackboneElement	Overall costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		0..1	CodeableConcept	Type of cost
groupSize		0..1	positiveInt	Number of enrollees
cost		0..1	Money	Cost value
comment		0..1	string	Additional cost information
specificCost		0..*	BackboneElement	Pharmacy benefit type specific cost
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	General category of benefit Binding: Pharmacy benefit types (extensible)
benefit		0..*	BackboneElement	Drug tier benefit
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of specific benefit Binding: Drug tier of medication in health plan (extensible)
cost		0..*	BackboneElement	List of the costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of cost
applicability		0..1	CodeableConcept	in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
qualifiers		0..*	CodeableConcept	Additional information about the cost
value		0..1	Quantity	The actual cost value
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
InsurancePlan.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
InsurancePlan.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
InsurancePlan.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	example	Pattern: DRUGPOL http://hl7.org/fhir/ValueSet/insuranceplan-type from the FHIR Standard
InsurancePlan.contact.purpose	extensible	ContactEntityType http://hl7.org/fhir/ValueSet/contactentity-type from the FHIR Standard
InsurancePlan.plan.specificCost.category	extensible	PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS from this IG
InsurancePlan.plan.specificCost.benefit.type	extensible	DrugTierVS (a valid code from Codes for medication drug tiers in health plans) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS from this IG
InsurancePlan.plan.specificCost.benefit.cost.applicability	required	BenefitCostApplicability http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 from the FHIR Standard

This structure is derived from InsurancePlan

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 6 elements

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
lastUpdated	SΣ	1..1	instant	When the resource version last changed ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣC	1..*	Identifier	Business Identifier for Product ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: DRUGPOL
name	SΣC	0..1	string	Official name ele-1: All FHIR elements must have a @value or children
period	S	0..1	Period	When the product is available ele-1: All FHIR elements must have a @value or children
plan		0..1	BackboneElement	Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Type of plan ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drug
display		1..1	string	Representation defined by the system Fixed Value: Drug
specificCost		0..*	BackboneElement	Pharmacy benefit type specific cost ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category		1..1	CodeableConcept	General category of benefit Binding: Pharmacy benefit types (extensible) ele-1: All FHIR elements must have a @value or children
benefit		0..*	BackboneElement	Drug tier benefit ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Type of specific benefit Binding: Drug tier of medication in health plan (extensible) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	example	Pattern: DRUGPOL http://hl7.org/fhir/ValueSet/insuranceplan-type from the FHIR Standard
InsurancePlan.plan.specificCost.category	extensible	PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS from this IG
InsurancePlan.plan.specificCost.benefit.type	extensible	DrugTierVS (a valid code from Codes for medication drug tiers in health plans) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS from this IG

Differential View

This structure is derived from InsurancePlan

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan		0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization
meta
lastUpdated	S	1..1	instant	When the resource version last changed
identifier	S	1..*	Identifier	Business Identifier for Product
status	S	1..1	code	draft | active | retired | unknown
type	S	1..1	CodeableConcept	Plan type Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: DRUGPOL
name	S	0..1	string	Official name
period	S	0..1	Period	When the product is available
plan		0..1	BackboneElement	Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary
type		1..1	CodeableConcept	Type of plan Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drug
display		1..1	string	Representation defined by the system Fixed Value: Drug
specificCost		0..*	BackboneElement	Pharmacy benefit type specific cost
category		1..1	CodeableConcept	General category of benefit Binding: Pharmacy benefit types (extensible)
benefit		0..*	BackboneElement	Drug tier benefit
type		1..1	CodeableConcept	Type of specific benefit Binding: Drug tier of medication in health plan (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
InsurancePlan.plan.specificCost.category	extensible	PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS from this IG
InsurancePlan.plan.specificCost.benefit.type	extensible	DrugTierVS (a valid code from Codes for medication drug tiers in health plans) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
InsurancePlan	C	0..*	InsurancePlan	Details of a Health Insurance product/plan provided by an organization ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣC	1..*	Identifier	Business Identifier for Product
status	?!SΣ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
type	SΣ	1..1	CodeableConcept	Plan type Binding: InsurancePlanType (example): Used to categorize the product/plan. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: DRUGPOL
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
name	SΣC	0..1	string	Official name
alias		0..*	string	Alternate names
period	S	0..1	Period	When the product is available
ownedBy	Σ	0..1	Reference(Organization)	Plan issuer
administeredBy	Σ	0..1	Reference(Organization)	Product administrator
coverageArea	Σ	0..*	Reference(Location)	Where product applies
contact		0..*	BackboneElement	Contact for the product
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
purpose		0..1	CodeableConcept	The type of contact Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
name		0..1	HumanName	A name associated with the contact
telecom		0..*	ContactPoint	Contact details (telephone, email, etc.) for a contact
address		0..1	Address	Visiting or postal addresses for the contact
endpoint		0..*	Reference(Endpoint)	Technical endpoint
network		0..*	Reference(Organization)	What networks are Included
coverage		0..*	BackboneElement	Coverage details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of coverage
network		0..*	Reference(Organization)	What networks provide coverage
benefit		1..*	BackboneElement	List of benefits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of benefit
requirement		0..1	string	Referral requirements
limit		0..*	BackboneElement	Benefit limits
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	Quantity	Maximum value allowed
code		0..1	CodeableConcept	Benefit limit details
plan		0..1	BackboneElement	Optional non-cost related plan information indicating pharmacy benefit types and drug tiers available in the formulary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier	Σ	0..*	Identifier	Business Identifier for Product
type		1..1	CodeableConcept	Type of plan Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drug
display		1..1	string	Representation defined by the system Fixed Value: Drug
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coverageArea	Σ	0..*	Reference(Location)	Where product applies
network		0..*	Reference(Organization)	What networks provide coverage
generalCost		0..*	BackboneElement	Overall costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		0..1	CodeableConcept	Type of cost
groupSize		0..1	positiveInt	Number of enrollees
cost		0..1	Money	Cost value
comment		0..1	string	Additional cost information
specificCost		0..*	BackboneElement	Pharmacy benefit type specific cost
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	General category of benefit Binding: Pharmacy benefit types (extensible)
benefit		0..*	BackboneElement	Drug tier benefit
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of specific benefit Binding: Drug tier of medication in health plan (extensible)
cost		0..*	BackboneElement	List of the costs
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Type of cost
applicability		0..1	CodeableConcept	in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
qualifiers		0..*	CodeableConcept	Additional information about the cost
value		0..1	Quantity	The actual cost value
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
InsurancePlan.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
InsurancePlan.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
InsurancePlan.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
InsurancePlan.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
InsurancePlan.type	example	Pattern: DRUGPOL http://hl7.org/fhir/ValueSet/insuranceplan-type from the FHIR Standard
InsurancePlan.contact.purpose	extensible	ContactEntityType http://hl7.org/fhir/ValueSet/contactentity-type from the FHIR Standard
InsurancePlan.plan.specificCost.category	extensible	PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/PharmacyBenefitTypeVS from this IG
InsurancePlan.plan.specificCost.benefit.type	extensible	DrugTierVS (a valid code from Codes for medication drug tiers in health plans) http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS from this IG
InsurancePlan.plan.specificCost.benefit.cost.applicability	required	BenefitCostApplicability http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1 from the FHIR Standard

This structure is derived from InsurancePlan

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 6 elements

Other representations of profile: CSV, Excel, Schematron