FHIRsmith: Basic/Basic-FormularyItem-D1002-1049640.json

FHIR IG analytics

Package	hl7.fhir.us.davinci-drug-formulary
Resource Type	Basic
Id	Basic-FormularyItem-D1002-1049640.json
FHIR Version	R4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Basic FormularyItem-D1002-1049640

Last updated: 2021-08-22 18:36:03+0000

Profile: Formulary Item

Formulary Reference: InsurancePlan Sample Medicare Advantage Part D Formulary D1002

Availability Status: active

Pharmacy Benefit Type: 3 month out of network retail

Drug Tier ID: Brand

Availability Period: 2021-01-01 --> 2021-12-31

Prior Authorization: true

Prior Authorization New Starts Only: true

Step Therapy Limit: true

Step Therapy Limit New Starts Only: false

Quantity Limit: true

Quantity Limit Detail
Rolling: Count 60 times, Once per 30 days
MaximumDaily: 2
DaysSupply: Count 1 times, Once per 180 days

Additional Coverage Information:

Prior Authorization required only with a newly started medication Step Therapy required.

code: Formulary Item

subject: MedicationKnowledge acetaminophen 325 MG / oxycodone hydrochloride 5 MG Oral Tablet [Percocet]

Source1

{
  "resourceType": "Basic",
  "id": "FormularyItem-D1002-1049640",
  "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": "3-month-out-retail",
            "display": "3 month out of 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": "brand",
            "display": "Brand"
          }
        ]
      }
    },
    {
      "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-PriorAuthorization-extension",
      "valueBoolean": true
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorizationNewStartsOnly-extension",
      "valueBoolean": true
    },
    {
      "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": false
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension",
      "valueBoolean": true
    },
    {
      "extension": [
        {
          "url": "Rolling",
          "valueTiming": {
            "repeat": {
              "count": 60,
              "period": 30,
              "periodUnit": "d"
            }
          }
        },
        {
          "url": "MaximumDaily",
          "valueQuantity": {
            "value": 2
          }
        },
        {
          "url": "DaysSupply",
          "valueTiming": {
            "repeat": {
              "boundsDuration": {
                "value": 365,
                "system": "http://unitsofmeasure.org",
                "code": "d"
              },
              "count": 1,
              "period": 180,
              "periodUnit": "d"
            }
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimitDetail-extension"
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-AdditionalCoverageInformation-extension",
      "valueMarkdown": "Prior Authorization required only with a newly started medication\nStep Therapy required."
    }
  ],
  "code": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS",
        "code": "formulary-item",
        "display": "Formulary Item"
      }
    ]
  },
  "subject": {
    "reference": "MedicationKnowledge/FormularyDrug-1049640"
  }
}