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Source1

{
  "resourceType": "Basic",
  "id": "FormularyItem-D1002-1000091",
  "meta": {
    "lastUpdated": "2021-08-22T18:36:03.000+00:00",
    "profile": [
      "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyItem"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension",
      "valueReference": {
        "reference": "InsurancePlan/FormularyD1002"
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityStatus-extension",
      "valueCode": "active"
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
            "code": "1-month-in-retail",
            "display": "1 month in network retail"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE",
            "code": "generic",
            "display": "Generic"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AvailabilityPeriod-extension",
      "valuePeriod": {
        "start": "2021-01-01",
        "end": "2021-12-31"
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
            "code": "1-month-in-mail",
            "display": "1 month in network mail order"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
            "code": "3-month-in-retail",
            "display": "3 month in network retail"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PharmacyBenefitType-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
            "code": "3-month-in-mail",
            "display": "3 month in network mail order"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension",
      "valueBoolean": false
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension",
      "valueBoolean": true
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimitNewStartsOnly-extension",
      "valueBoolean": true
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension",
      "valueBoolean": true
    }
  ],
  "code": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS",
        "code": "formulary-item",
        "display": "Formulary Item"
      }
    ]
  },
  "subject": {
    "reference": "MedicationKnowledge/FormularyDrug-1000091"
  }
}