Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-benefit-restriction | Version: 2.0.0 | |||
| Standards status: Trial-use Active as of 2020-05-23 | Maturity Level: 4 | Computable Name: RtbpcBenefitRestrictionValueSet | ||
This value set contains a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.
References
This value set contains a set of benefit restrictions 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.
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction version 📦2.0.0
Expansion performed internally based on codesystem RTPBC Benefit Restriction Code System v2.0.0 (CodeSystem)
This value set contains 11 concepts
| System | Code | Display (en) | Definition | JSON | XML |
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | covered | Covered | Covered | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | prior-auth | Prior authorization required | Covered with restriction: Prior authorization required | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | step-therapy | Step therapy applies | Covered with restriction: Step therapy applies | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | quantity-limit | Quantity limit applies | Covered with restriction: Quantity limit applies | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | pharmacy-restriction | Pharmacy restriction applies | Covered with restriction: Pharmacy restriction applies | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | other-restriction | Other restriction applies | Covered with restriction: Other restriction applies | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | not-covered | Not covered | Not covered | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | additional-fills-not-covered | Additional fills not covered | Additional fills are not covered | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | fill-too-soon | Fill too soon | Fill too soon | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | days-supply-limitation | Days supply limitation for product/service | Days supply limitation for the product/service | ||
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | route-not-covered | Route of administration not covered | Route of administration is not covered |
IG © 2024+ HL7 International / Pharmacy.
Package hl7.fhir.us.carin-rtpbc#2.0.0 based on FHIR 4.0.1.
Generated
2025-12-16
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