DaVinci Payer Data Exchange (PDex) US Drug Formulary
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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

CodeSystem: Codes qualifying the type of cost share amount

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE Version: 2.0.1
Standards status: Trial-use Computable Name: CostShareOptionCS

Codes for qualifier of copay amount

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE defines the following codes:

CodeDisplayDefinition
after-deductible After DeductibleThe consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the cost-share amount (this indicates that this benefit is subject to the deductible).
before-deductible Before DeductibleThe consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).
no-charge No ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductible No Charge After DeductibleThe consumer first pays the deductible, and after the deductible is met, no cost share amount is charged (this indicates that this benefit is subject to the deductible).
charge ChargeThe consumer always pays just the cost share amount and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).
coinsurance-not-applicable Coinsurance Not ApplicableThe consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs).
copay-not-applicable Copay Not 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-waived Deductible WaivedThe consumer pays the cost share amount with deductible requirement waived.