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-value-set
| Defining URL: | http://hl7.org/fhir/us/carin/ValueSet/rtpbc-coverage-summary |
| Version: | 0.1.0 |
| Name: | CarinRtbpcCoverageSummaryValueSet |
| Status: | Active |
| Title: | CARIN RTPBC Coverage Summary Value Set |
| Definition: | This value set contains 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. |
| Source Resource: | XML / JSON / Turtle |
This value set contains 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. In order to be meaningful to patients, this value set summarizes the range of coverage levels and restrictions into a smaller, more readily understandable group of values.
Used in...
Expansion
This value set contains 6 concepts
Expansion based on http://hl7.org/fhir/us/carin/CodeSystem/rtpbc-coverage-summary version 0.1.0
All codes from system http://hl7.org/fhir/us/carin/CodeSystem/rtpbc-coverage-summary
| 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 |
| other-restriction | Other restriction applies | Covered with restriction: Other restriction applies |
| not-covered | Not covered | Not covered |
