DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2 United States of America flag

This page is part of the US Drug Formulary (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Codes for benefit type of cost - XML Representation

Page standards status: Trial-use

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE</code> 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">copay<a name="usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE-copay"> </a></td><td>Copay</td><td>A flat fee the member pays to fill the prescription.</td></tr><tr><td style="white-space:nowrap">coinsurance<a name="usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE-coinsurance"> </a></td><td>Coinsurance</td><td>A percentage of the cost to fill the prescription, usually after the deductible has been met.</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="phx"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE"/>
  <version value="2.0.1"/>
  <name value="BenefitCostTypeCS"/>
  <title value="Codes for benefit type of cost"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2023-12-01T22:20:12+00:00"/>
  <publisher value="HL7 International / Pharmacy"/>
  <contact>
    <name value="HL7 International / Pharmacy"/>
    <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="Types of out of pockets costs associated with the benefit"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="2"/>
  <concept>
    <code value="copay"/>
    <display value="Copay"/>
    <definition value="A flat fee the member pays to fill the prescription."/>
  </concept>
  <concept>
    <code value="coinsurance"/>
    <display value="Coinsurance"/>
    <definition
                value="A percentage of the cost to fill the prescription, usually after the deductible has been met."/>
  </concept>
</CodeSystem>