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 of copay amount - XML Representation

Active as of 2022-08-25

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="CopayOptionVS"/>
  <text>
    <status value="extensions"/>
    <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-before-deductible">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><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-copay-not-applicable">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><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>
  </text>
  <url
       value="http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS"/>
  <version value="2.0.0"/>
  <name value="CopayOptionVS"/>
  <title value="Qualifier of copay amount"/>
  <status value="active"/>
  <date value="2022-08-25T13:09:53+00:00"/>
  <publisher value="HL7 Pharmacy Working Group"/>
  <contact>
    <name value="HL7 Pharmacy Working Group"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/medication"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pharmacy@lists.HL7.org"/>
    </telecom>
  </contact>
  <description value="Qualifier of copay amount"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system
              value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"/>
      <concept>
        <code value="after-deductible"/>
      </concept>
      <concept>
        <code value="before-deductible"/>
      </concept>
      <concept>
        <code value="no-charge"/>
      </concept>
      <concept>
        <code value="no-charge-after-deductible"/>
      </concept>
      <concept>
        <code value="charge"/>
      </concept>
      <concept>
        <code value="copay-not-applicable"/>
      </concept>
      <concept>
        <code value="deductible-waived"/>
      </concept>
    </include>
  </compose>
</ValueSet>