HL7.FHIR.US.CARIN-RTPBC\RtbpcBenefitRestrictionValueSet

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

ValueSet: RtbpcBenefitRestrictionValueSet

Summary

Defining URL:

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

Version:

1.0.0

Name:

RtbpcBenefitRestrictionValueSet

Status:

Active

Title:

RTPBC Benefit Restriction Value Set

Definition:

This value set contains 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

Source Resource:

XML / JSON / Turtle

References

RTPBC benefitRestriction Extension

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

Logical Definition (CLD)

Include all codes defined in http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction

Expansion

This value set contains 7 concepts

Expansion based on RTPBC Benefit Restriction Code System v1.0.0 (CodeSystem)

All codes from system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction

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

Explanation of the columns that may appear on this page:

Level

A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies

Source

The source of the definition of the code (when the value set draws in codes defined elsewhere)

Code

The code (used as the code in the resource instance)

Display

The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application

Definition

An explanation of the meaning of the concept

Comments

Additional notes about how to use the code