HL7.FHIR.US.CARIN-RTPBC\RtpbcBenefitRestrictionCodeSystem

This page is part of the Consumer Real-time Pharmacy Benefit Check (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

CodeSystem: RtpbcBenefitRestrictionCodeSystem

In order to be meaningful to patients, the system summarizes the range of coverage levels and restrictions into a smaller, more readily understandable group of values.

Summary

Defining URL:

http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction

Version:

1.0.0

Name:

RtpbcBenefitRestrictionCodeSystem

Title:

RTPBC Benefit Restriction Code System

Status:

Active

Content:

All the concepts defined by the code system are included in the code system resource

Definition:

This code system defines a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.

Publisher:

HL7 International - Pharmacy

Content Mode:

Complete

Source Resource:

XML / JSON / Turtle

This Code system is referenced in the content logical definition of the following value sets:

RtbpcBenefitRestrictionValueSet

This code system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction defines the following codes:

Code	Display	Definition
covered	Covered	Covered
prior-auth	Prior authorization required	Covered with restriction: Prior authorization required
step-therapy	Step therapy applies	Covered with restriction: Step therapy applies
quantity-limit	Quantity limit applies	Covered with restriction: Quantity limit applies
pharmacy-restriction	Pharmacy restriction applies	Covered with restriction: Pharmacy restriction applies
other-restriction	Other restriction applies	Covered with restriction: Other restriction applies
not-covered	Not covered	Not covered