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

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## Resource Profile: CoveragePlan - Detailed Descriptions

Definitions for the usdf-CoveragePlan resource profile.

1. List
Definition | A list is a curated collection of resources.
Control | 0..*
Alternate Names | Collection, WorkingList, Organizer
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.`div`.exists()) lst-1: A list can only have an emptyReason if it is empty (: emptyReason.empty() or entry.empty()) lst-2: The deleted flag can only be used if the mode of the list is "changes" (: mode = 'changes' or entry.deleted.empty()) lst-3: An entry date can only be used if the mode of the list is "working" (: mode = 'working' or entry.date.empty())
2. List.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | string
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
3. List.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. List.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Control | 0..1
Type | uri
Is Modifier | true
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. List.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages A human language.
Type | code
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. List.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control | 0..1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. List.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
8. List.extension
Definition | An Extension
Control | 4..*
Type | Extension
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
Slicing | This element introduces a set of slices on List.extension. The slices are unordered and Open, and can be differentiated using the following discriminators: value @ url
9. List.extension:usdf-DrugTierDefinition-extension
SliceName | usdf-DrugTierDefinition-extension
Definition | A description of the drug tiers used by the formulary and how those tiers implement copay and coinsurance amounts. Drug tiers do not have any inherent meaning that is consistent across all formularies. Rather, each tier is defined using this element.
Control | 1..* This element is affected by the following invariants: ele-1
Type | Extension(DrugTierDefinition) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. List.extension:usdf-Network-extension
SliceName | usdf-Network-extension
Definition | Array of Networks within a plan. If a network is not applicable for a plan, enter 'Not applicable' in the value string.
Control | 1..* This element is affected by the following invariants: ele-1
Type | Extension(Network) (Extension Type: string)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
11. List.extension:usdf-SummaryURL-extension
SliceName | usdf-SummaryURL-extension
Definition | The URL that goes directly to the formulary brochure for the specific standard plan or plan variation. If the formulary brochure is available in multiple languages, this can also point to a page listing the links for the various different language versions of the document supported by the payer.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Extension(SummaryURL) (Extension Type: url)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
12. List.extension:usdf-FormularyURL-extension
SliceName | usdf-FormularyURL-extension
Definition | The URL that goes directly to the formulary brochure for the specific standard plan or plan variation. If the formulary brochure is available in multiple languages, this can also point to a page listing the links for the various different language versions of the document supported by the payer.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(FormularyURL) (Extension Type: url)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
13. List.extension:usdf-EmailPlanContact-extension
SliceName | usdf-EmailPlanContact-extension
Definition | An email address for developers/public to report mistakes in the network and formulary data. FHIR URL type can be a web-url or an e-mail address.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(EmailPlanContact) (Extension Type: url)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
14. List.extension:usdf-MarketingURL-extension
SliceName | usdf-MarketingURL-extension
Definition | The URL that goes directly to the plan brochure for the specific standard plan or plan variation. If the plan brochure is available in multiple languages, this can also point to a page listing the links for the various different language versions of the document supported by the payer.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(MarketingURL) (Extension Type: url)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
15. List.extension:usdf-PlanIDType-extension
SliceName | usdf-PlanIDType-extension
Definition | Type of Plan ID. For all Marketplace plans this should be: HIOS-PLAN-ID. For all other plans this should be: OTHER-PLAN-ID.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Extension(PlanIDType) (Extension Type: string)
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
16. List.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
17. List.identifier
Definition | Identifier for the List assigned for business purposes outside the context of FHIR.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. List.status
Definition | Indicates the current state of this list.
Control | 1..1
Binding | The codes SHALL be taken from ListStatus The current state of the list.
Type | code
Is Modifier | true
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. List.mode
Definition | How this list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.
Control | 1..1
Binding | The codes SHALL be taken from ListMode The processing mode that applies to this list.
Type | code
Is Modifier | true
Requirements | Lists are used in various ways, and it must be known in what way it is safe to use them.
Comments | This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. List.title
Definition | A label for the list assigned by the author.
Control | 0..1
Type | string
Requirements | Allows customization beyond just the code identifying the kind of list.
Example | General:Dr. Jane's Patients
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. List.code
Definition | This code defines the purpose of the list - why it was created.
Control | 1..1
Binding | For example codes, see ExampleUseCodesForList What the purpose of a list is.
Type | CodeableConcept
Requirements | Lists often contain subsets of resources rather than an exhaustive list. The code identifies what type of subset is included.
Comments | If there is no code, the purpose of the list is implied where it is used, such as in a document section using Document.section.code.
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> <code value="DRUGPOL"/> </coding> </valueCodeableConcept>
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. List.subject
Definition | The common subject (or patient) of the resources that are in the list if there is one.
Control | 0..1
Type | Reference(Patient | Group | Device | Location)
Requirements | The primary purpose of listing the subject explicitly is to help with finding the right list.
Comments | Some purely arbitrary lists do not have a common subject, so this is optional.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. List.encounter
Definition | The encounter that is the context in which this list was created.
Control | 0..1
Type | Reference(Encounter)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. List.date
Definition | The date that the list was prepared.
Control | 0..1
Type | dateTime
Requirements | Identifies how current the list is which affects relevance.
Comments | The actual important date is the date of currency of the resources that were summarized, but it is usually assumed that these are current when the preparation occurs.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. List.source
Definition | The entity responsible for deciding what the contents of the list were. Where the list was created by a human, this is the same as the author of the list.
Control | 0..1
Type | Reference(Practitioner | PractitionerRole | Patient | Device)
Requirements | Allows follow-up as well as context.
Alternate Names | Author
Comments | The primary source is the entity that made the decisions what items are in the list. This may be software or user.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. List.orderedBy
Definition | What order applies to the items in the list.
Control | 0..1
Binding | The codes SHOULD be taken from ListOrderCodes What order applies to the items in a list.
Type | CodeableConcept
Requirements | Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.
Comments | Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. List.note
Definition | Comments that apply to the overall list.
Control | 0..*
Type | Annotation
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. List.entry
Definition | Entries in this list.
Control | 0..* This element is affected by the following invariants: lst-1
Type | BackboneElement
Comments | If there are no entries in the list, an emptyReason SHOULD be provided.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. List.entry.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
30. List.entry.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
31. List.entry.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Control | 0..*
Type | Extension
Is Modifier | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
32. List.entry.flag
Definition | The flag allows the system constructing the list to indicate the role and significance of the item in the list.
Control | 0..1
Binding | For example codes, see PatientMedicineChangeTypes Codes that provide further information about the reason and meaning of the item in the list.
Type | CodeableConcept
Requirements | This field is present to support various clinical uses of lists, such as a discharge summary medication list, where flags specify whether the medication was added, modified, or deleted from the list.
Comments | The flag can only be understood in the context of the List.code. If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. Deleted can only be used if the List.mode is "changes".
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
33. List.entry.deleted
Definition | True if this item is marked as deleted in the list.
Control | 0..1 This element is affected by the following invariants: lst-2
Type | boolean
Is Modifier | true
Requirements | The flag element may contain codes that an application processing the list does not understand. However there can be no ambiguity if a list item is actually marked as "deleted".
Comments | If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. Both flag and deleted can only be used if the List.mode is "changes". A deleted entry should be displayed in narrative as deleted. This element is labeled as a modifier because it indicates that an item is (to be) no longer in the list.
Meaning if Missing | List items are generally only treated as deleted when this element explicitly carries a value of true. Systems SHOULD always populate this value when mode is 'changes'
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. List.entry.date
Definition | When this item was added to the list.
Control | 0..1
Type | dateTime
Requirements | The date may be significant for understanding the meaning of items in a working list.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. List.entry.item
Definition | A reference to the actual resource from which data was derived.
Control | 1..1
Type | Reference(Resource)
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. List.emptyReason
Definition | If the list is empty, why the list is empty.
Control | 0..1 This element is affected by the following invariants: lst-1
Binding | The codes SHOULD be taken from ListEmptyReasons If a list is empty, why it is empty.
Type | CodeableConcept
Requirements | Allows capturing things like "none exist" or "not asked" which can be important for most lists.
Comments | The various reasons for an empty list make a significant interpretation to its interpretation. Note that this code is for use when the entire list has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))