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

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## Resource Profile: Formulary Coverage Plan

Defining URL: | http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan
Version: | 1.1.0
Name: | CoveragePlan
Title: | Formulary Coverage Plan
Status: | Active as of 2021-10-15T15:46:55+00:00
Definition: | A health plan which contains links to administrative information, a list of formulary drugs covered under that plan, and a definition of drug tiers and their associated cost-sharing models.
Publisher: | HL7 Pharmacy Working Group
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan

Note: Future versions of this Implementation Guide may base the CoveragePlan profile on the InsurancePlan resource instead of the List resource.

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from List

Summary

Mandatory: 5 elements
Must-Support: 7 elements

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension

This structure is derived from List

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
List |  | 0..* | List | A list is a curated collection of resources
Slices for extension |  | 4..* | Extension | Extension Slice: Unordered, Open by value:url
usdf-DrugTierDefinition-extension | S | 1..* | (Complex) | Drug Tier Definition URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
usdf-Network-extension | S | 1..* | string | Network URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
usdf-SummaryURL-extension | S | 1..1 | url | Summary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
usdf-FormularyURL-extension | S | 0..1 | url | Formulary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
usdf-EmailPlanContact-extension | S | 0..1 | url | Email Plan Contact URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
usdf-MarketingURL-extension | S | 0..1 | url | Marketing URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
usdf-PlanIDType-extension | S | 1..1 | string | Plan ID Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
code |  | 1..1 | CodeableConcept | What the purpose of this list is Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
List | I | 0..* | List | A list is a curated collection of resources
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 4..* | Extension | Extension Slice: Unordered, Open by value:url
usdf-DrugTierDefinition-extension | S | 1..* | (Complex) | Drug Tier Definition URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
usdf-Network-extension | S | 1..* | string | Network URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
usdf-SummaryURL-extension | S | 1..1 | url | Summary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
usdf-FormularyURL-extension | S | 0..1 | url | Formulary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
usdf-EmailPlanContact-extension | S | 0..1 | url | Email Plan Contact URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
usdf-MarketingURL-extension | S | 0..1 | url | Marketing URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
usdf-PlanIDType-extension | S | 1..1 | string | Plan ID Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier
status | ?!Σ | 1..1 | code | current | retired | entered-in-error Binding: ListStatus (required): The current state of the list.
mode | ?!Σ | 1..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this list.
title | Σ | 0..1 | string | Descriptive name for the list Example General: Dr. Jane's Patients
code | Σ | 1..1 | CodeableConcept | What the purpose of this list is Binding: ExampleUseCodesForList (example): What the purpose of a list is. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
subject | Σ | 0..1 | Reference(Patient | Group | Device | Location) | If all resources have the same subject
encounter |  | 0..1 | Reference(Encounter) | Context in which list created
date | Σ | 0..1 | dateTime | When the list was prepared
source | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | Device) | Who and/or what defined the list contents (aka Author)
orderedBy |  | 0..1 | CodeableConcept | What order the list has Binding: ListOrderCodes (preferred): What order applies to the items in a list.
note |  | 0..* | Annotation | Comments about the list
entry | I | 0..* | BackboneElement | Entries in the list
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
flag |  | 0..1 | CodeableConcept | Status/Workflow information about this item Binding: PatientMedicineChangeTypes (example): Codes that provide further information about the reason and meaning of the item in the list.
deleted | ?!I | 0..1 | boolean | If this item is actually marked as deleted
date |  | 0..1 | dateTime | When item added to list
item |  | 1..1 | Reference(Resource) | Actual entry
emptyReason | I | 0..1 | CodeableConcept | Why list is empty Binding: ListEmptyReasons (preferred): If a list is empty, why it is empty.
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
List | I | 0..* | List | A list is a curated collection of resources
usdf-DrugTierDefinition-extension |  | 1..* | (Complex) | Drug Tier Definition URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
usdf-Network-extension |  | 1..* | string | Network URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
usdf-SummaryURL-extension |  | 1..1 | url | Summary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
usdf-FormularyURL-extension |  | 0..1 | url | Formulary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
usdf-EmailPlanContact-extension |  | 0..1 | url | Email Plan Contact URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
usdf-MarketingURL-extension |  | 0..1 | url | Marketing URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
usdf-PlanIDType-extension |  | 1..1 | string | Plan ID Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
Documentation for this format

This structure is derived from List

Summary

Mandatory: 5 elements
Must-Support: 7 elements

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension

Differential View

This structure is derived from List

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
List |  | 0..* | List | A list is a curated collection of resources
Slices for extension |  | 4..* | Extension | Extension Slice: Unordered, Open by value:url
usdf-DrugTierDefinition-extension | S | 1..* | (Complex) | Drug Tier Definition URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
usdf-Network-extension | S | 1..* | string | Network URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
usdf-SummaryURL-extension | S | 1..1 | url | Summary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
usdf-FormularyURL-extension | S | 0..1 | url | Formulary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
usdf-EmailPlanContact-extension | S | 0..1 | url | Email Plan Contact URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
usdf-MarketingURL-extension | S | 0..1 | url | Marketing URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
usdf-PlanIDType-extension | S | 1..1 | string | Plan ID Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
code |  | 1..1 | CodeableConcept | What the purpose of this list is Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
List | I | 0..* | List | A list is a curated collection of resources
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 4..* | Extension | Extension Slice: Unordered, Open by value:url
usdf-DrugTierDefinition-extension | S | 1..* | (Complex) | Drug Tier Definition URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
usdf-Network-extension | S | 1..* | string | Network URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
usdf-SummaryURL-extension | S | 1..1 | url | Summary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
usdf-FormularyURL-extension | S | 0..1 | url | Formulary URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyURL-extension
usdf-EmailPlanContact-extension | S | 0..1 | url | Email Plan Contact URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-EmailPlanContact-extension
usdf-MarketingURL-extension | S | 0..1 | url | Marketing URL URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-MarketingURL-extension
usdf-PlanIDType-extension | S | 1..1 | string | Plan ID Type URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier
status | ?!Σ | 1..1 | code | current | retired | entered-in-error Binding: ListStatus (required): The current state of the list.
mode | ?!Σ | 1..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this list.
title | Σ | 0..1 | string | Descriptive name for the list Example General: Dr. Jane's Patients
code | Σ | 1..1 | CodeableConcept | What the purpose of this list is Binding: ExampleUseCodesForList (example): What the purpose of a list is. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
subject | Σ | 0..1 | Reference(Patient | Group | Device | Location) | If all resources have the same subject
encounter |  | 0..1 | Reference(Encounter) | Context in which list created
date | Σ | 0..1 | dateTime | When the list was prepared
source | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | Device) | Who and/or what defined the list contents (aka Author)
orderedBy |  | 0..1 | CodeableConcept | What order the list has Binding: ListOrderCodes (preferred): What order applies to the items in a list.
note |  | 0..* | Annotation | Comments about the list
entry | I | 0..* | BackboneElement | Entries in the list
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
flag |  | 0..1 | CodeableConcept | Status/Workflow information about this item Binding: PatientMedicineChangeTypes (example): Codes that provide further information about the reason and meaning of the item in the list.
deleted | ?!I | 0..1 | boolean | If this item is actually marked as deleted
date |  | 0..1 | dateTime | When item added to list
item |  | 1..1 | Reference(Resource) | Actual entry
emptyReason | I | 0..1 | CodeableConcept | Why list is empty Binding: ListEmptyReasons (preferred): If a list is empty, why it is empty.
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet / Code
List.language | preferred | CommonLanguages Max Binding: AllLanguages
List.status | required | ListStatus
List.mode | required | ListMode
List.code | example | Pattern: DRUGPOL
List.orderedBy | preferred | ListOrderCodes
List.entry.flag | example | PatientMedicineChangeTypes
List.emptyReason | preferred | ListEmptyReasons