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

## ValueSet: RTPBC Benefit Restriction Value Set

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

- RTPBC benefitRestriction Extension

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.

### Logical Definition (CLD)

- Include all codes defined in `http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction` version 📦2.0.0

### Expansion

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 |  |

Description of the above table(s).