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
: RTPBC Benefit Restriction Code System - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "rtpbc-benefit-restriction"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem rtpbc-benefit-restriction</b></p><a name=\"rtpbc-benefit-restriction\"> </a><a name=\"hcrtpbc-benefit-restriction\"> </a><p>This case-insensitive code system <code>http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction</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\">covered<a name=\"rtpbc-benefit-restriction-covered\"> </a></td><td>Covered</td><td>Covered</td></tr><tr><td style=\"white-space:nowrap\">prior-auth<a name=\"rtpbc-benefit-restriction-prior-auth\"> </a></td><td>Prior authorization required</td><td>Covered with restriction: Prior authorization required</td></tr><tr><td style=\"white-space:nowrap\">step-therapy<a name=\"rtpbc-benefit-restriction-step-therapy\"> </a></td><td>Step therapy applies</td><td>Covered with restriction: Step therapy applies</td></tr><tr><td style=\"white-space:nowrap\">quantity-limit<a name=\"rtpbc-benefit-restriction-quantity-limit\"> </a></td><td>Quantity limit applies</td><td>Covered with restriction: Quantity limit applies</td></tr><tr><td style=\"white-space:nowrap\">pharmacy-restriction<a name=\"rtpbc-benefit-restriction-pharmacy-restriction\"> </a></td><td>Pharmacy restriction applies</td><td>Covered with restriction: Pharmacy restriction applies</td></tr><tr><td style=\"white-space:nowrap\">other-restriction<a name=\"rtpbc-benefit-restriction-other-restriction\"> </a></td><td>Other restriction applies</td><td>Covered with restriction: Other restriction applies</td></tr><tr><td style=\"white-space:nowrap\">not-covered<a name=\"rtpbc-benefit-restriction-not-covered\"> </a></td><td>Not covered</td><td>Not covered</td></tr></table></div>"^^rdf:XMLLiteral
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "phx" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ] ;
fhir:value [
a fhir:integer ;
fhir:v 4 ;
( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
a fhir:canonical ;
fhir:v "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc> ] ] ) ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "trial-use" ;
( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
a fhir:canonical ;
fhir:v "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc> ] ] ) ]
] ) ; #
fhir:url [ fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction"^^xsd:anyURI] ; #
fhir:version [ fhir:v "2.0.0"] ; #
fhir:name [ fhir:v "RtpbcBenefitRestrictionCodeSystem"] ; #
fhir:title [ fhir:v "RTPBC Benefit Restriction Code System"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v false] ; #
fhir:date [ fhir:v "2020-05-23T00:00:00-05:00"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "HL7 International / Pharmacy"] ; #
fhir:contact ( [
fhir:name [ fhir:v "HL7 International / Pharmacy" ] ;
( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/medication" ] ] )
] [
fhir:name [ fhir:v "Frank McKinney" ] ;
( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "fm@frankmckinney.com" ] ] )
] ) ; #
fhir:description [ fhir:v "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."] ; #
fhir:jurisdiction ( [
( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ] ;
fhir:display [ fhir:v "United States of America" ] ] )
] ) ; #
fhir:caseSensitive [ fhir:v false] ; #
fhir:content [ fhir:v "complete"] ; #
fhir:count [ fhir:v "7"^^xsd:nonNegativeInteger] ; #
fhir:concept ( [
fhir:code [ fhir:v "covered" ] ;
fhir:display [ fhir:v "Covered" ] ;
fhir:definition [ fhir:v "Covered" ]
] [
fhir:code [ fhir:v "prior-auth" ] ;
fhir:display [ fhir:v "Prior authorization required" ] ;
fhir:definition [ fhir:v "Covered with restriction: Prior authorization required" ]
] [
fhir:code [ fhir:v "step-therapy" ] ;
fhir:display [ fhir:v "Step therapy applies" ] ;
fhir:definition [ fhir:v "Covered with restriction: Step therapy applies" ]
] [
fhir:code [ fhir:v "quantity-limit" ] ;
fhir:display [ fhir:v "Quantity limit applies" ] ;
fhir:definition [ fhir:v "Covered with restriction: Quantity limit applies" ]
] [
fhir:code [ fhir:v "pharmacy-restriction" ] ;
fhir:display [ fhir:v "Pharmacy restriction applies" ] ;
fhir:definition [ fhir:v "Covered with restriction: Pharmacy restriction applies" ]
] [
fhir:code [ fhir:v "other-restriction" ] ;
fhir:display [ fhir:v "Other restriction applies" ] ;
fhir:definition [ fhir:v "Covered with restriction: Other restriction applies" ]
] [
fhir:code [ fhir:v "not-covered" ] ;
fhir:display [ fhir:v "Not covered" ] ;
fhir:definition [ fhir:v "Not covered" ]
] ) . #
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