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
: Codes qualifying the type of cost share amount
Raw ttl | Download
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"] ;
fhir:Resource.language [ fhir:value "en"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE</b></p><a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE\"> </a><a name=\"hcusdf-CostShareOptionCS-TEMPORARY-TRIAL-USE\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">after-deductible<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-after-deductible\"> </a></td><td>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 style=\"white-space:nowrap\">before-deductible<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-before-deductible\"> </a></td><td>Before Deductible</td><td>The consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">no-charge<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge\"> </a></td><td>No Charge</td><td>No cost sharing is charged (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">no-charge-after-deductible<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge-after-deductible\"> </a></td><td>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 style=\"white-space:nowrap\">charge<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-charge\"> </a></td><td>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 style=\"white-space:nowrap\">coinsurance-not-applicable<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-coinsurance-not-applicable\"> </a></td><td>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 style=\"white-space:nowrap\">copay-not-applicable<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-copay-not-applicable\"> </a></td><td>Copay Not Applicable</td><td>Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.</td></tr><tr><td style=\"white-space:nowrap\">deductible-waived<a name=\"usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-deductible-waived\"> </a></td><td>Deductible Waived</td><td>The consumer pays the cost share amount with deductible requirement waived.</td></tr></table></div>"
] ;
fhir:DomainResource.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:Extension.valueCode [ fhir:value "phx" ]
], [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:Extension.valueCode [
fhir:value "trial-use" ;
fhir:Element.extension [
fhir:index -1 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
fhir:Extension.valueCanonical [
fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary" ;
fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary>
]
]
]
] ;
fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"] ;
fhir:CodeSystem.identifier [
fhir:index -1 ;
fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ] ;
fhir:Identifier.value [ fhir:value "urn:oid:2.25.74595174031514506193398850787025340071.16.2" ]
] ;
fhir:CodeSystem.version [ fhir:value "2.1.0"] ;
fhir:CodeSystem.name [ fhir:value "CostShareOptionCS"] ;
fhir:CodeSystem.title [ fhir:value "Codes qualifying the type of cost share amount"] ;
fhir:CodeSystem.status [ fhir:value "active"] ;
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2026-08-03T19:19:34+00:00"^^xsd:dateTime] ;
fhir:CodeSystem.publisher [ fhir:value "HL7 International / Pharmacy"] ;
fhir:CodeSystem.contact [
fhir:index -1 ;
fhir:ContactDetail.name [ fhir:value "HL7 International / Pharmacy" ] ;
fhir:ContactDetail.telecom [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/medication" ]
], [
fhir:index -1 ;
fhir:ContactPoint.system [ fhir:value "email" ] ;
fhir:ContactPoint.value [ fhir:value "pharmacy@lists.HL7.org" ]
]
] ;
fhir:CodeSystem.description [ fhir:value "Codes for qualifier of copay amount"] ;
fhir:CodeSystem.jurisdiction [
fhir:index -1 ;
fhir:CodeableConcept.coding [
fhir:index -1 ;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
fhir:Coding.code [ fhir:value "US" ]
]
] ;
fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ;
fhir:CodeSystem.content [ fhir:value "complete"] ;
fhir:CodeSystem.count [ fhir:value "8"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "after-deductible" ] ;
fhir:CodeSystem.concept.display [ fhir:value "After Deductible" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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)." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "before-deductible" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Before Deductible" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible)." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "no-charge" ] ;
fhir:CodeSystem.concept.display [ fhir:value "No Charge" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "No cost sharing is charged (this indicates that this benefit is not subject to the deductible)." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "no-charge-after-deductible" ] ;
fhir:CodeSystem.concept.display [ fhir:value "No Charge After Deductible" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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)." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "charge" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Charge" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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)." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "coinsurance-not-applicable" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Coinsurance Not Applicable" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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)." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "copay-not-applicable" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Copay Not Applicable" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'." ]
], [
fhir:index -1 ;
fhir:CodeSystem.concept.code [ fhir:value "deductible-waived" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Deductible Waived" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The consumer pays the cost share amount with deductible requirement waived." ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.ttl> .
|
Propose a change