DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.0 - STU 2 US

This page is part of the US Drug Formulary (v2.0.0: STU 2) based on FHIR 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 qualifying the type of cost share amount - TTL Representation

Active as of 2022-08-25

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE 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\">after-deductible<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-after-deductible\"> </a></td><td>After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the cost-share amount (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">before-deductible<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-before-deductible\"> </a></td><td>Before Deductible</td><td>The consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">no-charge<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge\"> </a></td><td>No Charge</td><td>No cost sharing is charged (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">no-charge-after-deductible<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge-after-deductible\"> </a></td><td>No Charge After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, no cost share amount is charged (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">charge<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-charge\"> </a></td><td>Charge</td><td>The consumer always pays just the cost share amount and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">coinsurance-not-applicable<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-coinsurance-not-applicable\"> </a></td><td>Coinsurance Not Applicable</td><td>The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs).</td></tr><tr><td style=\"white-space:nowrap\">copay-not-applicable<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-copay-not-applicable\"> </a></td><td>Copay Not Applicable</td><td>Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.</td></tr><tr><td style=\"white-space:nowrap\">deductible-waived<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-deductible-waived\"> </a></td><td>Deductible Waived</td><td>The consumer pays the cost share amount with deductible requirement waived.</td></tr></table></div>"
  ];
  fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"];
  fhir:CodeSystem.version [ fhir:value "2.0.0"];
  fhir:CodeSystem.name [ fhir:value "CostShareOptionCS"];
  fhir:CodeSystem.title [ fhir:value "Codes qualifying the type of cost share amount"];
  fhir:CodeSystem.status [ fhir:value "active"];
  fhir:CodeSystem.date [ fhir:value "2022-08-25T13:09:53+00:00"^^xsd:dateTime];
  fhir:CodeSystem.publisher [ fhir:value "HL7 Pharmacy Working Group"];
  fhir:CodeSystem.contact [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "HL7 Pharmacy Working Group" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/medication" ]     ], [
       fhir:index 1;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "pharmacy@lists.HL7.org" ]     ]
  ];
  fhir:CodeSystem.description [ fhir:value "Codes for qualifier of copay amount"];
  fhir:CodeSystem.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ]     ]
  ];
  fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean];
  fhir:CodeSystem.content [ fhir:value "complete"];
  fhir:CodeSystem.count [ fhir:value "8"^^xsd:nonNegativeInteger];
  fhir:CodeSystem.concept [
     fhir:index 0;
     fhir:CodeSystem.concept.code [ fhir:value "after-deductible" ];
     fhir:CodeSystem.concept.display [ fhir:value "After Deductible" ];
     fhir:CodeSystem.concept.definition [ fhir:value "The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the cost-share amount (this indicates that this benefit is subject to the deductible)." ]
  ], [
     fhir:index 1;
     fhir:CodeSystem.concept.code [ fhir:value "before-deductible" ];
     fhir:CodeSystem.concept.display [ fhir:value "Before Deductible" ];
     fhir:CodeSystem.concept.definition [ fhir:value "The consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible)." ]
  ], [
     fhir:index 2;
     fhir:CodeSystem.concept.code [ fhir:value "no-charge" ];
     fhir:CodeSystem.concept.display [ fhir:value "No Charge" ];
     fhir:CodeSystem.concept.definition [ fhir:value "No cost sharing is charged (this indicates that this benefit is not subject to the deductible)." ]
  ], [
     fhir:index 3;
     fhir:CodeSystem.concept.code [ fhir:value "no-charge-after-deductible" ];
     fhir:CodeSystem.concept.display [ fhir:value "No Charge After Deductible" ];
     fhir:CodeSystem.concept.definition [ fhir:value "The consumer first pays the deductible, and after the deductible is met, no cost share amount is charged (this indicates that this benefit is subject to the deductible)." ]
  ], [
     fhir:index 4;
     fhir:CodeSystem.concept.code [ fhir:value "charge" ];
     fhir:CodeSystem.concept.display [ fhir:value "Charge" ];
     fhir:CodeSystem.concept.definition [ fhir:value "The consumer always pays just the cost share amount and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible)." ]
  ], [
     fhir:index 5;
     fhir:CodeSystem.concept.code [ fhir:value "coinsurance-not-applicable" ];
     fhir:CodeSystem.concept.display [ fhir:value "Coinsurance Not Applicable" ];
     fhir:CodeSystem.concept.definition [ fhir:value "The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs)." ]
  ], [
     fhir:index 6;
     fhir:CodeSystem.concept.code [ fhir:value "copay-not-applicable" ];
     fhir:CodeSystem.concept.display [ fhir:value "Copay Not Applicable" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'." ]
  ], [
     fhir:index 7;
     fhir:CodeSystem.concept.code [ fhir:value "deductible-waived" ];
     fhir:CodeSystem.concept.display [ fhir:value "Deductible Waived" ];
     fhir:CodeSystem.concept.definition [ fhir:value "The consumer pays the cost share amount with deductible requirement waived." ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.