CARIN Consumer Realtime Pharmacy Benefit Check

This page is part of the Consumer Real-time Pharmacy Benefit Check (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

carin-rtpbc-coverage-summary-code-system

CARIN RTPBC Coverage Summary Code System

This code system defines a set of coverage outcomes that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.

This code system http://hl7.org/fhir/us/carin/CodeSystem/rtpbc-coverage-summary defines the following codes:

Code	Display	Definition
covered	Covered	Covered
prior-auth	Prior authorization required	Covered with restriction: Prior authorization required
step-therapy	Step therapy applies	Covered with restriction: Step therapy applies
quantity-limit	Quantity limits apply	Covered with restriction: Quantity limits apply
pharmacy-restriction	Pharmacy restriction applies	Pharmacy restriction applies
other-restriction	Other restriction applies	Covered with restriction: Other restriction applies
not-covered	Not covered	Not covered

Defining URL:

http://hl7.org/fhir/us/carin/CodeSystem/rtpbc-coverage-summary

Version:

0.1.0

Name:

CarinRtpbcCoverageSummaryCodeSystem

Title:

CARIN RTPBC Coverage Summary Code System

Status:

Active

Content:

All the concepts defined by the code system are included in the code system resource

Definition:

This code system defines a set of coverage outcomes that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.

Publisher:

CARIN Alliance

Source Resource:

XML / JSON / Turtle

In order to be meaningful to patients, the system summarizes the range of coverage levels and restrictions into a smaller, more readily understandable group of values.