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

Publication Build: This will be filled in by the publication tooling

## Example MedicationKnowledge: Formulary Drug V1002

Generated Narrative

Drug Tier ID: Brand

Prior Authorization: false

Step Therapy Limit: false

Quantity Limit: false

Plan ID: 40308VA0240008

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

### Notes:

Field | Value
resourceType | "MedicationKnowledge"
meta.profile[0] | "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyDrug"
id | "formularydrugV1002"
extension[0].url | "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierID-extension"
extension[0].valueCodeableConcept.coding[0].system | "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"
extension[0].valueCodeableConcept.coding[0].code | #brand
extension[0].valueCodeableConcept.coding[0].display | "Brand"
extension[1].url | "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PriorAuthorization-extension"
extension[1].valueBoolean | "false"
extension[2].url | "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-StepTherapyLimit-extension"
extension[2].valueBoolean | "false"
extension[3].url | "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-QuantityLimit-extension"
extension[3].valueBoolean | "false"
extension[4].url | "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanID-extension"
extension[4].valueString | "40308VA0240008"
code.coding[0].system | "http://www.nlm.nih.gov/research/umls/rxnorm"
code.coding[0].code | #1049640
code.coding[0].display | "Percocet 5 MG / 325 MG Oral Tablet"