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Packagehl7.fhir.us.davinci-drug-formulary.r4
Resource TypeBasic
IdBasic-FormularyItem-D1002-209459.json
FHIR VersionR4

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Narrative

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

Generated Narrative: Basic FormularyItem-D1002-209459

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

Step Therapy Limit: false

Quantity Limit: false

code: Formulary Item

subject: MedicationKnowledge acetaminophen 500 MG Oral Tablet [Tylenol]

Source1

{
  "resourceType": "Basic",
  "id": "FormularyItem-D1002-209459",
  "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-StepTherapyLimit-extension",
      "valueBoolean": false
    },
    {
      "url": "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension",
      "valueBoolean": false
    }
  ],
  "code": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-InsuranceItemTypeCS",
        "code": "formulary-item",
        "display": "Formulary Item"
      }
    ]
  },
  "subject": {
    "reference": "MedicationKnowledge/FormularyDrug-209459"
  }
}