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 - XML Representation

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="CoinsuranceOptionVS"/>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="phx"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS"/>
  <version value="2.1.0"/>
  <name value="CoinsuranceOptionVS"/>
  <title value="Qualifier for coinsurance rate"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-12-16T22:00:26+00:00"/>
  <publisher value="HL7 International / Pharmacy"/>
  <contact>
    <name value="HL7 International / Pharmacy"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/medication"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pharmacy@lists.HL7.org"/>
    </telecom>
  </contact>
  <description value="Qualifier for coinsurance rate"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system
              value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"/>
      <concept>
        <code value="after-deductible"/>
      </concept>
      <concept>
        <code value="no-charge"/>
      </concept>
      <concept>
        <code value="no-charge-after-deductible"/>
      </concept>
      <concept>
        <code value="charge"/>
      </concept>
      <concept>
        <code value="coinsurance-not-applicable"/>
      </concept>
      <concept>
        <code value="deductible-waived"/>
      </concept>
    </include>
  </compose>
</ValueSet>