DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pdex-formulary/ and changes regularly. See the Directory of published versions

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: Qualifier for coinsurance rate - JSON Representation

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{
  "resourceType" : "ValueSet",
  "id" : "CoinsuranceOptionVS",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet CoinsuranceOptionVS</b></p><a name=\"CoinsuranceOptionVS\"> </a><a name=\"hcCoinsuranceOptionVS\"> </a><a name=\"CoinsuranceOptionVS-en-US\"> </a><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 style=\"color: #cccccc\">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-no-charge\">no-charge</a></td><td style=\"color: #cccccc\">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 style=\"color: #cccccc\">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 style=\"color: #cccccc\">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-coinsurance-not-applicable\">coinsurance-not-applicable</a></td><td style=\"color: #cccccc\">Coinsurance Not Applicable</td><td>The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs).</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 style=\"color: #cccccc\">Deductible Waived</td><td>The consumer pays the cost share amount with deductible requirement waived.</td></tr></table></li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "phx"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS",
  "version" : "2.1.0",
  "name" : "CoinsuranceOptionVS",
  "title" : "Qualifier for coinsurance rate",
  "status" : "active",
  "experimental" : false,
  "date" : "2024-12-16T22:00:26+00:00",
  "publisher" : "HL7 International / Pharmacy",
  "contact" : [
    {
      "name" : "HL7 International / Pharmacy",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/medication"
        },
        {
          "system" : "email",
          "value" : "pharmacy@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "Qualifier for coinsurance rate",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "compose" : {
    "include" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE",
        "concept" : [
          {
            "code" : "after-deductible"
          },
          {
            "code" : "no-charge"
          },
          {
            "code" : "no-charge-after-deductible"
          },
          {
            "code" : "charge"
          },
          {
            "code" : "coinsurance-not-applicable"
          },
          {
            "code" : "deductible-waived"
          }
        ]
      }
    ]
  }
}