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 
JSON Format: CodeSystem-carin-rtpbc-coverage-summary-code-system
Raw json
{
"resourceType" : "CodeSystem",
"id" : "carin-rtpbc-coverage-summary-code-system",
"meta" : {
"lastUpdated" : "2019-12-08T05:00:00.000+00:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h2>CARIN RTPBC Coverage Summary Code System</h2><div><p>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.</p>\n</div><p>This code system http://hl7.org/fhir/us/carin/CodeSystem/rtpbc-coverage-summary 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\">covered<a name=\"carin-rtpbc-coverage-summary-code-system-covered\"> </a></td><td>Covered</td><td>Covered</td></tr><tr><td style=\"white-space:nowrap\">prior-auth<a name=\"carin-rtpbc-coverage-summary-code-system-prior-auth\"> </a></td><td>Prior authorization required</td><td>Covered with restriction: Prior authorization required</td></tr><tr><td style=\"white-space:nowrap\">step-therapy<a name=\"carin-rtpbc-coverage-summary-code-system-step-therapy\"> </a></td><td>Step therapy applies</td><td>Covered with restriction: Step therapy applies</td></tr><tr><td style=\"white-space:nowrap\">quantity-limit<a name=\"carin-rtpbc-coverage-summary-code-system-quantity-limit\"> </a></td><td>Quantity limits apply</td><td>Covered with restriction: Quantity limits apply</td></tr><tr><td style=\"white-space:nowrap\">pharmacy-restriction<a name=\"carin-rtpbc-coverage-summary-code-system-pharmacy-restriction\"> </a></td><td>Pharmacy restriction applies</td><td>Pharmacy restriction applies</td></tr><tr><td style=\"white-space:nowrap\">other-restriction<a name=\"carin-rtpbc-coverage-summary-code-system-other-restriction\"> </a></td><td>Other restriction applies</td><td>Covered with restriction: Other restriction applies</td></tr><tr><td style=\"white-space:nowrap\">not-covered<a name=\"carin-rtpbc-coverage-summary-code-system-not-covered\"> </a></td><td>Not covered</td><td>Not covered</td></tr></table></div>"
},
"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",
"experimental" : false,
"date" : "2019-12-08T05:00:00+00:00",
"publisher" : "CARIN Alliance",
"description" : "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.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}
]
}
],
"caseSensitive" : false,
"content" : "complete",
"concept" : [
{
"code" : "covered",
"display" : "Covered",
"definition" : "Covered"
},
{
"code" : "prior-auth",
"display" : "Prior authorization required",
"definition" : "Covered with restriction: Prior authorization required"
},
{
"code" : "step-therapy",
"display" : "Step therapy applies",
"definition" : "Covered with restriction: Step therapy applies"
},
{
"code" : "quantity-limit",
"display" : "Quantity limits apply",
"definition" : "Covered with restriction: Quantity limits apply"
},
{
"code" : "pharmacy-restriction",
"display" : "Pharmacy restriction applies",
"definition" : "Pharmacy restriction applies"
},
{
"code" : "other-restriction",
"display" : "Other restriction applies",
"definition" : "Covered with restriction: Other restriction applies"
},
{
"code" : "not-covered",
"display" : "Not covered",
"definition" : "Not covered"
}
]
}
