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

: Qualifier for coinsurance rate - 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:ValueSet;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "CoinsuranceOptionVS"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li>Include these codes as defined in <a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html\"><code>http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-after-deductible\">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><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge\">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><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge-after-deductible\">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><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-charge\">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><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-coinsurance-not-applicable\">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><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-deductible-waived\">deductible-waived</a></td><td>Deductible Waived</td><td>The consumer pays the cost share amount with deductible requirement waived.</td></tr></table></li></ul></div>"
  ];
  fhir:ValueSet.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS"];
  fhir:ValueSet.version [ fhir:value "2.0.0"];
  fhir:ValueSet.name [ fhir:value "CoinsuranceOptionVS"];
  fhir:ValueSet.title [ fhir:value "Qualifier for coinsurance rate"];
  fhir:ValueSet.status [ fhir:value "active"];
  fhir:ValueSet.date [ fhir:value "2022-08-25T13:09:53+00:00"^^xsd:dateTime];
  fhir:ValueSet.publisher [ fhir:value "HL7 Pharmacy Working Group"];
  fhir:ValueSet.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:ValueSet.description [ fhir:value "Qualifier for coinsurance rate"];
  fhir:ValueSet.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:ValueSet.compose [
     fhir:ValueSet.compose.include [
       fhir:index 0;
       fhir:ValueSet.compose.include.system [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "after-deductible" ]       ], [
         fhir:index 1;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "no-charge" ]       ], [
         fhir:index 2;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "no-charge-after-deductible" ]       ], [
         fhir:index 3;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "charge" ]       ], [
         fhir:index 4;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "coinsurance-not-applicable" ]       ], [
         fhir:index 5;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "deductible-waived" ]       ]     ]
  ].

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

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