Consumer Real-Time Pharmacy Benefit Check
1.0.0 - STU1

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

: RtpbcBenefitRestrictionCodeSystem - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "rtpbc-benefit-restriction"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">covered<a name=\"rtpbc-benefit-restriction-covered\"> </a></td><td>Covered</td><td>Covered</td></tr><tr><td style=\"white-space:nowrap\">prior-auth<a name=\"rtpbc-benefit-restriction-prior-auth\"> </a></td><td>Prior authorization required</td><td>Covered with restriction: Prior authorization required</td></tr><tr><td style=\"white-space:nowrap\">step-therapy<a name=\"rtpbc-benefit-restriction-step-therapy\"> </a></td><td>Step therapy applies</td><td>Covered with restriction: Step therapy applies</td></tr><tr><td style=\"white-space:nowrap\">quantity-limit<a name=\"rtpbc-benefit-restriction-quantity-limit\"> </a></td><td>Quantity limit applies</td><td>Covered with restriction: Quantity limit applies</td></tr><tr><td style=\"white-space:nowrap\">pharmacy-restriction<a name=\"rtpbc-benefit-restriction-pharmacy-restriction\"> </a></td><td>Pharmacy restriction applies</td><td>Covered with restriction: Pharmacy restriction applies</td></tr><tr><td style=\"white-space:nowrap\">other-restriction<a name=\"rtpbc-benefit-restriction-other-restriction\"> </a></td><td>Other restriction applies</td><td>Covered with restriction: Other restriction applies</td></tr><tr><td style=\"white-space:nowrap\">not-covered<a name=\"rtpbc-benefit-restriction-not-covered\"> </a></td><td>Not covered</td><td>Not covered</td></tr></table></div>"
  ];
  fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction"];
  fhir:CodeSystem.version [ fhir:value "1.0.0"];
  fhir:CodeSystem.name [ fhir:value "RtpbcBenefitRestrictionCodeSystem"];
  fhir:CodeSystem.title [ fhir:value "RTPBC Benefit Restriction Code System"];
  fhir:CodeSystem.status [ fhir:value "active"];
  fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean];
  fhir:CodeSystem.date [ fhir:value "2020-05-23T00:00:00-05:00"^^xsd:dateTime];
  fhir:CodeSystem.publisher [ fhir:value "HL7 International - Pharmacy"];
  fhir:CodeSystem.contact [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "HL7 International - Pharmacy" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/medication" ]     ]
  ], [
     fhir:index 1;
     fhir:ContactDetail.name [ fhir:value "Frank McKinney" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "frank.mckinney@pocp.com" ]     ]
  ];
  fhir:CodeSystem.description [ fhir:value "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."];
  fhir:CodeSystem.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ];
       fhir:Coding.display [ fhir:value "United States of America" ]     ]
  ];
  fhir:CodeSystem.caseSensitive [ fhir:value "false"^^xsd:boolean];
  fhir:CodeSystem.content [ fhir:value "complete"];
  fhir:CodeSystem.concept [
     fhir:index 0;
     fhir:CodeSystem.concept.code [ fhir:value "covered" ];
     fhir:CodeSystem.concept.display [ fhir:value "Covered" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Covered" ]
  ], [
     fhir:index 1;
     fhir:CodeSystem.concept.code [ fhir:value "prior-auth" ];
     fhir:CodeSystem.concept.display [ fhir:value "Prior authorization required" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Covered with restriction: Prior authorization required" ]
  ], [
     fhir:index 2;
     fhir:CodeSystem.concept.code [ fhir:value "step-therapy" ];
     fhir:CodeSystem.concept.display [ fhir:value "Step therapy applies" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Covered with restriction: Step therapy applies" ]
  ], [
     fhir:index 3;
     fhir:CodeSystem.concept.code [ fhir:value "quantity-limit" ];
     fhir:CodeSystem.concept.display [ fhir:value "Quantity limit applies" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Covered with restriction: Quantity limit applies" ]
  ], [
     fhir:index 4;
     fhir:CodeSystem.concept.code [ fhir:value "pharmacy-restriction" ];
     fhir:CodeSystem.concept.display [ fhir:value "Pharmacy restriction applies" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Covered with restriction: Pharmacy restriction applies" ]
  ], [
     fhir:index 5;
     fhir:CodeSystem.concept.code [ fhir:value "other-restriction" ];
     fhir:CodeSystem.concept.display [ fhir:value "Other restriction applies" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Covered with restriction: Other restriction applies" ]
  ], [
     fhir:index 6;
     fhir:CodeSystem.concept.code [ fhir:value "not-covered" ];
     fhir:CodeSystem.concept.display [ fhir:value "Not covered" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Not covered" ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.