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

## Extension: RTPBC benefitRestriction Extension

Official URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction | Version: 2.0.0
Standards status: Trial-use Active as of 2020-05-23 | Maturity Level: 1 | Computable Name: RtpbcExtensionBenefitRestriction

This extension conveys benefit restrictions that may apply to a prescription product and pharmacy combination.

Context of Use

This extension may be used on the following element(s)

- Element ID: `ClaimResponse.item`
- Element ID: `ClaimResponse.addItem`

This extension enables a real-time pharmacy benefit check responder to indicate one or more benefit restrictions that apply to:

- the requested medication and pharmacy
- an alternative medication and pharmacy

Values conveyed in this extension are defined in the RTPBC Benefit Restriction value set.

Usage info

Usages:

- Use this Extension: RTPBC Response Using ClaimResponse
- Examples for this Extension: Bundle/rtpbc-bundle-response-03, ClaimResponse/rtpbc-claim-response-03 and ClaimResponse/rtpbc-claim-response-not-covered

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit restriction.
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x] |  | 1..1 | Coding | Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | extensible | RTPBC Benefit Restriction Value Set | 📦2.0.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit restriction.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x] |  | 1..1 | Coding | Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | extensible | RTPBC Benefit Restriction Value Set | 📦2.0.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Simple Extension with the type Coding: This extension conveys benefit restrictions that may apply to a prescription product and pharmacy combination.

Maturity: 1

Differential ViewDifferential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit restriction.
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x] |  | 1..1 | Coding | Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | extensible | RTPBC Benefit Restriction Value Set | 📦2.0.0 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Benefit restriction.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x] |  | 1..1 | Coding | Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | extensible | RTPBC Benefit Restriction Value Set | 📦2.0.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Simple Extension with the type Coding: This extension conveys benefit restrictions that may apply to a prescription product and pharmacy combination.

Maturity: 1

Other representations of profile: CSV, Excel, Schematron