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

ValueSet: Qualifier of copay amount

Summary

Defining URL:http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS
Version:1.2.0
Name:CopayOptionVS
Title:Qualifier of copay amount
Status:Active as of 12/3/21 6:37 PM
Definition:

Qualifier of copay amount

Publisher:HL7 Pharmacy Working Group
Source Resource:XML / JSON / Turtle

References

Logical Definition (CLD)

 

Expansion

This value set contains 7 concepts

Expansion based on Codes for qualifier of copay amount v1.2.0 (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS

CodeDisplayDefinition
after-deductibleAfter DeductibleThe 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).
before-deductibleBefore DeductibleThe 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).
no-chargeNo ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductibleNo Charge After DeductibleThe 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).
chargeChargeThe 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).
not-applicableNot ApplicableDeductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.
deductible-waivedDeductible WaivedThe consumer pays the copay with deductible requirement waived.

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