DaVinci Payer Data Exchange (PDex) US Drug Formulary | STU2 Ballot
1.2.0 - STU2 Ballot

This page is part of the US Drug Formulary (v1.2.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

: Codes for qualifier of copay amount - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="usdf-CopayOptionCS"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS 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">after-deductible<a name="usdf-CopayOptionCS-after-deductible"> </a></td><td>After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style="white-space:nowrap">before-deductible<a name="usdf-CopayOptionCS-before-deductible"> </a></td><td>Before Deductible</td><td>The consumer first pays the copay, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style="white-space:nowrap">no-charge<a name="usdf-CopayOptionCS-no-charge"> </a></td><td>No Charge</td><td>No cost sharing is charged (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style="white-space:nowrap">no-charge-after-deductible<a name="usdf-CopayOptionCS-no-charge-after-deductible"> </a></td><td>No Charge After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, no copayment is charged (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style="white-space:nowrap">charge<a name="usdf-CopayOptionCS-charge"> </a></td><td>Charge</td><td>The consumer always pays just the copay and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style="white-space:nowrap">not-applicable<a name="usdf-CopayOptionCS-not-applicable"> </a></td><td>Not Applicable</td><td>Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.</td></tr><tr><td style="white-space:nowrap">deductible-waived<a name="usdf-CopayOptionCS-deductible-waived"> </a></td><td>Deductible Waived</td><td>The consumer pays the copay with deductible requirement waived.</td></tr></table></div>
  </text>
  <url
       value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS"/>
  <version value="1.2.0"/>
  <name value="CopayOptionCS"/>
  <title value="Codes for qualifier of copay amount"/>
  <status value="active"/>
  <date value="2021-12-03T18:37:11+00:00"/>
  <publisher value="HL7 Pharmacy Working Group"/>
  <contact>
    <name value="HL7 Pharmacy Working Group"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/medication"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pharmacy@lists.HL7.org"/>
    </telecom>
  </contact>
  <description value="Codes for qualifier of copay amount"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="7"/>
  <concept>
    <code value="after-deductible"/>
    <display value="After Deductible"/>
    <definition
                value="The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible)."/>
  </concept>
  <concept>
    <code value="before-deductible"/>
    <display value="Before Deductible"/>
    <definition
                value="The consumer first pays the copay, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible)."/>
  </concept>
  <concept>
    <code value="no-charge"/>
    <display value="No Charge"/>
    <definition
                value="No cost sharing is charged (this indicates that this benefit is not subject to the deductible)."/>
  </concept>
  <concept>
    <code value="no-charge-after-deductible"/>
    <display value="No Charge After Deductible"/>
    <definition
                value="The consumer first pays the deductible, and after the deductible is met, no copayment is charged (this indicates that this benefit is subject to the deductible)."/>
  </concept>
  <concept>
    <code value="charge"/>
    <display value="Charge"/>
    <definition
                value="The consumer always pays just the copay and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible)."/>
  </concept>
  <concept>
    <code value="not-applicable"/>
    <display value="Not Applicable"/>
    <definition
                value="Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of &#39;Not applicable&#39; and co-insurance value of &#39;No charge&#39;."/>
  </concept>
  <concept>
    <code value="deductible-waived"/>
    <display value="Deductible Waived"/>
    <definition
                value="The consumer pays the copay with deductible requirement waived."/>
  </concept>
</CodeSystem>