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 
XML Format: CodeSystem-carin-rtpbc-coverage-summary-code-system
Raw xml
<CodeSystem xmlns="http://hl7.org/fhir"> <id value="carin-rtpbc-coverage-summary-code-system"/> <meta> <lastUpdated value="2019-12-08T05:00:00.000+00:00"/> </meta> <text> <status value="generated"/> <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> </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> </text> <url value="http://hl7.org/fhir/us/carin/CodeSystem/rtpbc-coverage-summary"/> <version value="0.1.0"/> <name value="CarinRtpbcCoverageSummaryCodeSystem"/> <title value="CARIN RTPBC Coverage Summary Code System"/> <status value="active"/> <experimental value="false"/> <date value="2019-12-08T05:00:00+00:00"/> <publisher value="CARIN Alliance"/> <description value="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 value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <caseSensitive value="false"/> <content value="complete"/> <concept> <code value="covered"/> <display value="Covered"/> <definition value="Covered"/> </concept> <concept> <code value="prior-auth"/> <display value="Prior authorization required"/> <definition value="Covered with restriction: Prior authorization required"/> </concept> <concept> <code value="step-therapy"/> <display value="Step therapy applies"/> <definition value="Covered with restriction: Step therapy applies"/> </concept> <concept> <code value="quantity-limit"/> <display value="Quantity limits apply"/> <definition value="Covered with restriction: Quantity limits apply"/> </concept> <concept> <code value="pharmacy-restriction"/> <display value="Pharmacy restriction applies"/> <definition value="Pharmacy restriction applies"/> </concept> <concept> <code value="other-restriction"/> <display value="Other restriction applies"/> <definition value="Covered with restriction: Other restriction applies"/> </concept> <concept> <code value="not-covered"/> <display value="Not covered"/> <definition value="Not covered"/> </concept> </CodeSystem>
