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

## CodeSystem: RTPBC Formulary Status Code System

Official URL: http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-formulary-status | Version: 2.0.0
Standards status: Trial-use Active as of 2025-10-03 | Maturity Level: 4 | Computable Name: RtpbcFormularyStatusCodeSystem

This code system defines formulary statuses that may apply to a prescription product evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.

This Code system is referenced in the definition of the following value sets:

- RtbpcFormularyStatusValueSet

This case-insensitive code system `http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-formulary-status` defines the following codes:

Code | Display | Definition
B | Brand Preferred | Indicates the payer prefers the brand over the generic
C | Carve-Out | This medication is processed by a third party, not the payer providing the formulary
N | Non-Formulary | Response code indicating that the prescribed drug is not included in the plan formulary
O | On Formulary | The medication submitted is included in the list of payable products in that patient's plan formulary but that there may be a more preferred product in the therapeutic category
P | On Formulary/Preferred | The medication is the preferred payable products in that patient's plan formulary
U | Unknown | Unknown
X | Non-Reimbursable without authorization | This medication is not covered although an exception or appeal process may exist
Y | Non-Reimbursable | The medication will never be reimbursable by the payer with no appeal process
Z | Zero Dollar Copay | This medication does not have a copay. The cost is $0 to the patient

Description of the above table(s).