@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:InsurancePlan ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "PayerInsurancePlanA3004t"] ; # fhir:meta [ fhir:lastUpdated [ fhir:v "2021-08-04T18:36:03.000+00:00"^^xsd:dateTime ] ; fhir:profile ( [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan"^^xsd:anyURI ; fhir:l ] ) ] ; # fhir:language [ fhir:v "en"] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div [ fhir:v "

Generated Narrative: InsurancePlan PayerInsurancePlanA3004t

Last updated: 2021-08-04 18:36:03+0000

Profile: Payer Insurance Plan

identifier: A3004t

status: Active

type: Medicare Advantage

name: Sample Medicare Advantage Plan A3004t

period: 2021-01-01 --> 2021-12-31

coverageArea: Location United States Area

contact

purpose: Patient

telecom: +1 (888) 555-3004

contact

purpose: Marketting

name: Sample Medicare Advantage Plan Marketing Website

telecom: http://url/to/health/plan/information

contact

purpose: Summary

name: Sample Medicare Advantage Drug Plan Benefit Website

telecom: http://url/to/health/plan/information

contact

purpose: Formulary

name: Sample Medicare Advantage Drug Plan Formulary Website

telecom: http://url/to/health/plan/information

coverage

Formulary Reference: InsurancePlan Sample Medicare Advantage Part D Formulary D3004t

type: drug policy

Benefits

-Type
*Drug

plan

type: Drug

specificCost

category: 1 month in network retail

benefit

type: Generic

cost

type: Copay

qualifiers: No Charge

value: 10 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month out of network retail

benefit

type: Generic

cost

type: Copay

qualifiers: No Charge

value: 10 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month in network retail

benefit

type: Generic

cost

type: Copay

qualifiers: No Charge

value: 20 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month out of network retail

benefit

type: Generic

cost

type: Copay

qualifiers: No Charge

value: 20 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month in network retail

benefit

type: Zero cost-share preventative

cost

type: Copay

qualifiers: No Charge

value: 0 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: No Charge

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month out of network retail

benefit

type: Zero cost-share preventative

cost

type: Copay

qualifiers: No Charge

value: 0 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: No Charge

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month in network retail

benefit

type: Zero cost-share preventative

cost

type: Copay

qualifiers: No Charge

value: 0 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: No Charge

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month out of network retail

benefit

type: Zero cost-share preventative

cost

type: Copay

qualifiers: No Charge

value: 0 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: No Charge

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month in network retail

benefit

type: Preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 50 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month out of network retail

benefit

type: Preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 50 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month in network retail

benefit

type: Preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 100 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month out of network retail

benefit

type: Preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 100 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month in network retail

benefit

type: Non-preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 70 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month out of network retail

benefit

type: Non-preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 70 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month in network retail

benefit

type: Non-preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 140 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month out of network retail

benefit

type: Non-preferred Brand

cost

type: Copay

qualifiers: No Charge

value: 140 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month in network retail

benefit

type: Specialty

cost

type: Copay

qualifiers: No Charge

value: 100 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 1 month out of network retail

benefit

type: Specialty

cost

type: Copay

qualifiers: No Charge

value: 100 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month in network retail

benefit

type: Specialty

cost

type: Copay

qualifiers: No Charge

value: 200 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

specificCost

category: 3 month out of network retail

benefit

type: Specialty

cost

type: Copay

qualifiers: No Charge

value: 200 $ (Details: unknown codeUSD = 'United States dollar')

cost

type: Coinsurance

qualifiers: After Deductible

value: 0 % (Details: UCUM code% = '%')

"^^rdf:XMLLiteral ] ] ; # fhir:identifier ( [ fhir:value [ fhir:v "A3004t" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "mediadv" ] ] ) ] ) ; # fhir:name [ fhir:v "Sample Medicare Advantage Plan A3004t"] ; # fhir:period [ fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2021-12-31"^^xsd:date ] ] ; # fhir:coverageArea ( [ fhir:l ; fhir:reference [ fhir:v "Location/UnitedStatesLocation" ] ] ) ; # fhir:contact ( [ fhir:purpose [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/contactentity-type"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "PATINF" ] ] ) ] ; fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "+1 (888) 555-3004" ] ] ) ] [ fhir:purpose [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "MARKETING" ] ] ) ] ; fhir:name [ fhir:text [ fhir:v "Sample Medicare Advantage Plan Marketing Website" ] ] ; fhir:telecom ( [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://url/to/health/plan/information" ] ] ) ] [ fhir:purpose [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "SUMMARY" ] ] ) ] ; fhir:name [ fhir:text [ fhir:v "Sample Medicare Advantage Drug Plan Benefit Website" ] ] ; fhir:telecom ( [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://url/to/health/plan/information" ] ] ) ] [ fhir:purpose [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PlanContactTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FORMULARY" ] ] ) ] ; fhir:name [ fhir:text [ fhir:v "Sample Medicare Advantage Drug Plan Formulary Website" ] ] ; fhir:telecom ( [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://url/to/health/plan/information" ] ] ) ] ) ; # fhir:coverage ( [ fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Reference ; fhir:l ; fhir:reference [ fhir:v "InsurancePlan/FormularyD3004t" ] ] ] ) ; fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "DRUGPOL" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/insurance-plan-type"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "drug" ] ; fhir:display [ fhir:v "Drug" ] ] ) ] ] ) ] ) ; # fhir:plan ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/insurance-plan-type"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "drug" ] ; fhir:display [ fhir:v "Drug" ] ] ) ] ; fhir:specificCost ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-in-retail" ] ; fhir:display [ fhir:v "1 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "generic" ] ; fhir:display [ fhir:v "Generic" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "10"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-out-retail" ] ; fhir:display [ fhir:v "1 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "generic" ] ; fhir:display [ fhir:v "Generic" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "10"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-in-retail" ] ; fhir:display [ fhir:v "3 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "generic" ] ; fhir:display [ fhir:v "Generic" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "20"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-out-retail" ] ; fhir:display [ fhir:v "3 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "generic" ] ; fhir:display [ fhir:v "Generic" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "20"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-in-retail" ] ; fhir:display [ fhir:v "1 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "zero-cost-share-preventative" ] ; fhir:display [ fhir:v "Zero cost-share preventative" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-out-retail" ] ; fhir:display [ fhir:v "1 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "zero-cost-share-preventative" ] ; fhir:display [ fhir:v "Zero cost-share preventative" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-in-retail" ] ; fhir:display [ fhir:v "3 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "zero-cost-share-preventative" ] ; fhir:display [ fhir:v "Zero cost-share preventative" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-out-retail" ] ; fhir:display [ fhir:v "3 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "zero-cost-share-preventative" ] ; fhir:display [ fhir:v "Zero cost-share preventative" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-in-retail" ] ; fhir:display [ fhir:v "1 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "preferred-brand" ] ; fhir:display [ fhir:v "Preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "50"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-out-retail" ] ; fhir:display [ fhir:v "1 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "preferred-brand" ] ; fhir:display [ fhir:v "Preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "50"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-in-retail" ] ; fhir:display [ fhir:v "3 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "preferred-brand" ] ; fhir:display [ fhir:v "Preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-out-retail" ] ; fhir:display [ fhir:v "3 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "preferred-brand" ] ; fhir:display [ fhir:v "Preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-in-retail" ] ; fhir:display [ fhir:v "1 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "non-preferred-brand" ] ; fhir:display [ fhir:v "Non-preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "70"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-out-retail" ] ; fhir:display [ fhir:v "1 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "non-preferred-brand" ] ; fhir:display [ fhir:v "Non-preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "70"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-in-retail" ] ; fhir:display [ fhir:v "3 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "non-preferred-brand" ] ; fhir:display [ fhir:v "Non-preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "140"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-out-retail" ] ; fhir:display [ fhir:v "3 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "non-preferred-brand" ] ; fhir:display [ fhir:v "Non-preferred Brand" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "140"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-in-retail" ] ; fhir:display [ fhir:v "1 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "specialty" ] ; fhir:display [ fhir:v "Specialty" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "1-month-out-retail" ] ; fhir:display [ fhir:v "1 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "specialty" ] ; fhir:display [ fhir:v "Specialty" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-in-retail" ] ; fhir:display [ fhir:v "3 month in network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "specialty" ] ; fhir:display [ fhir:v "Specialty" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "3-month-out-retail" ] ; fhir:display [ fhir:v "3 month out of network retail" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "specialty" ] ; fhir:display [ fhir:v "Specialty" ] ] ) ] ; fhir:cost ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "copay" ] ; fhir:display [ fhir:v "Copay" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "no-charge" ] ; fhir:display [ fhir:v "No Charge" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "200"^^xsd:decimal ] ; fhir:unit [ fhir:v "$" ] ; fhir:system [ fhir:v "urn:iso:std:iso:4217"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "coinsurance" ] ; fhir:display [ fhir:v "Coinsurance" ] ] ) ] ; fhir:qualifiers ( [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "after-deductible" ] ; fhir:display [ fhir:v "After Deductible" ] ] ) ] ) ; fhir:value [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "%" ] ] ] ) ] ) ] ) ] ) . # a fhir:Us . a fhir:Us . # -------------------------------------------------------------------------------------