DaVinci Payer Data Exchange (PDex) US Drug Formulary
1.1.0 - STU 1.1

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## : Formulary Drug V3002 - XML Representation

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    <MedicationKnowledge xmlns="http://hl7.org/fhir">
      <id value="FormularyDrugV3002"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>Drug Tier ID</b>: <span title="Codes: {http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS brand}">Brand</span></p><p><b>Prior Authorization</b>: false</p><p><b>Step Therapy Limit</b>: false</p><p><b>Quantity Limit</b>: false</p><p><b>Mail Order</b>: true</p><p><b>Plan ID</b>: 40308VA0240008</p><p><b>code</b>: <span title="Codes: {http://www.nlm.nih.gov/research/umls/rxnorm 209459}">acetaminophen 500 MG Oral Tablet [Tylenol]</span></p></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
            <code value="brand"/>
            <display value="Brand"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension">
        <valueBoolean value="false"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension">
        <valueBoolean value="false"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension">
        <valueBoolean value="false"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MailOrder-extension">
        <valueBoolean value="true"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanID-extension">
        <valueString value="40308VA0240008"/>
      </extension>
      <code>
        <coding>
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
          <code value="209459"/>
          <display value="acetaminophen 500 MG Oral Tablet [Tylenol]"/>
        </coding>
      </code>
    </MedicationKnowledge>