Consumer Real-Time Pharmacy Benefit Check FHIR IG
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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

CodeSystem: RTPBC Benefit Restriction Code System

Official URL: http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction Version: 2.0.0
Standards status: Trial-use Maturity Level: 4 Computable Name: RtpbcBenefitRestrictionCodeSystem

This code system defines 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, the system summarizes the range of coverage levels and restrictions into a smaller, more readily understandable group of values.


This Code system is referenced in the content logical definition of the following value sets:

This case-insensitive code system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction defines the following codes:

CodeDisplayDefinition
covered Covered Covered
prior-auth Prior authorization required Covered with restriction: Prior authorization required
step-therapy Step therapy applies Covered with restriction: Step therapy applies
quantity-limit Quantity limit applies Covered with restriction: Quantity limit applies
pharmacy-restriction Pharmacy restriction applies Covered with restriction: Pharmacy restriction applies
other-restriction Other restriction applies Covered with restriction: Other restriction applies
not-covered Not covered Not covered