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

• Narrative Content
• XML
• JSON
• TTL

: RTPBC Benefit Restriction Code System - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="rtpbc-benefit-restriction"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="phx"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="4">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"/>
      </extension>
    </valueInteger>
  </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/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction"/>
  <version value="2.0.0"/>
  <name value="RtpbcBenefitRestrictionCodeSystem"/>
  <title value="RTPBC Benefit Restriction Code System"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2020-05-23T00:00:00-05:00"/>
  <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>
  </contact>
  <contact>
    <name value="Frank McKinney"/>
    <telecom>
      <system value="email"/>
      <value value="fm@frankmckinney.com"/>
    </telecom>
  </contact>
  <description
               value="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."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="false"/>
  <content value="complete"/>
  <count value="7"/>
  <concept>
    <code value="covered"/>
    <display value="Covered"/>
    <definition value="Covered"/>
  </concept>
  <concept>
    <code value="prior-auth"/>
    <display value="Prior authorization required"/>
    <definition
                value="Covered with restriction: Prior authorization required"/>
  </concept>
  <concept>
    <code value="step-therapy"/>
    <display value="Step therapy applies"/>
    <definition value="Covered with restriction: Step therapy applies"/>
  </concept>
  <concept>
    <code value="quantity-limit"/>
    <display value="Quantity limit applies"/>
    <definition value="Covered with restriction: Quantity limit applies"/>
  </concept>
  <concept>
    <code value="pharmacy-restriction"/>
    <display value="Pharmacy restriction applies"/>
    <definition
                value="Covered with restriction: Pharmacy restriction applies"/>
  </concept>
  <concept>
    <code value="other-restriction"/>
    <display value="Other restriction applies"/>
    <definition value="Covered with restriction: Other restriction applies"/>
  </concept>
  <concept>
    <code value="not-covered"/>
    <display value="Not covered"/>
    <definition value="Not covered"/>
  </concept>
</CodeSystem>