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

: Codes for pharmacy benefit types - JSON Representation

Page standards status: Trial-use

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{
  "resourceType" : "CodeSystem",
  "id" : "usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
  "text" : {
    "status" : "generated",
    "div" : "<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-PharmacyBenefitTypeCS-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\">1-month-in-retail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-1-month-in-retail\"> </a></td><td>1 month in network retail</td><td>1 Month Supply via in-network retail pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">1-month-out-retail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-1-month-out-retail\"> </a></td><td>1 month out of network retail</td><td>1 Month Supply via out-of-network retail pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">1-month-in-mail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-1-month-in-mail\"> </a></td><td>1 month in network mail order</td><td>1 Month Supply via in-network mail order pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">1-month-out-mail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-1-month-out-mail\"> </a></td><td>1 month out of network mail order</td><td>1 Month Supply via out-of-network mail order pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">3-month-in-retail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-3-month-in-retail\"> </a></td><td>3 month in network retail</td><td>3 Month Supply via in-network retail pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">3-month-out-retail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-3-month-out-retail\"> </a></td><td>3 month out of network retail</td><td>3 Month Supply via out-of-network retail pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">3-month-in-mail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-3-month-in-mail\"> </a></td><td>3 month in network mail order</td><td>3 Month Supply via in-network mail order pharmacy.</td></tr><tr><td style=\"white-space:nowrap\">3-month-out-mail<a name=\"usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE-3-month-out-mail\"> </a></td><td>3 month out of network mail order</td><td>3 Month Supply via out-of-network mail order pharmacy.</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "phx"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-PharmacyBenefitTypeCS-TEMPORARY-TRIAL-USE",
  "version" : "2.0.1",
  "name" : "PharmacyBenefitTypeCS",
  "title" : "Codes for pharmacy benefit types",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-12-01T22:20:12+00:00",
  "publisher" : "HL7 International / Pharmacy",
  "contact" : [
    {
      "name" : "HL7 International / Pharmacy",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/medication"
        },
        {
          "system" : "email",
          "value" : "pharmacy@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "Codes for pharmacy benefit types. Each payer will have its own controlled vocabulary.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 8,
  "concept" : [
    {
      "code" : "1-month-in-retail",
      "display" : "1 month in network retail",
      "definition" : "1 Month Supply via in-network retail pharmacy."
    },
    {
      "code" : "1-month-out-retail",
      "display" : "1 month out of network retail",
      "definition" : "1 Month Supply via out-of-network retail pharmacy."
    },
    {
      "code" : "1-month-in-mail",
      "display" : "1 month in network mail order",
      "definition" : "1 Month Supply via in-network mail order pharmacy."
    },
    {
      "code" : "1-month-out-mail",
      "display" : "1 month out of network mail order",
      "definition" : "1 Month Supply via out-of-network mail order pharmacy."
    },
    {
      "code" : "3-month-in-retail",
      "display" : "3 month in network retail",
      "definition" : "3 Month Supply via in-network retail pharmacy."
    },
    {
      "code" : "3-month-out-retail",
      "display" : "3 month out of network retail",
      "definition" : "3 Month Supply via out-of-network retail pharmacy."
    },
    {
      "code" : "3-month-in-mail",
      "display" : "3 month in network mail order",
      "definition" : "3 Month Supply via in-network mail order pharmacy."
    },
    {
      "code" : "3-month-out-mail",
      "display" : "3 month out of network mail order",
      "definition" : "3 Month Supply via out-of-network mail order pharmacy."
    }
  ]
}