Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
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
| Official URL: http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-benefit-restriction | Version: 2.0.0 | |||
| Standards status: Trial-use | Maturity Level: 4 | Computable Name: RtbpcBenefitRestrictionValueSet | ||
This value set contains 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.
References
This value set contains 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, this value set summarizes the range of coverage levels and restrictions into a smaller, more readily understandable group of values.
http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction
Expansion performed internally based on codesystem RTPBC Benefit Restriction Code System v2.0.0 (CodeSystem)
This value set contains 7 concepts
| Code | System | Display | Definition |
| covered | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Covered | Covered |
| prior-auth | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Prior authorization required | Covered with restriction: Prior authorization required |
| step-therapy | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Step therapy applies | Covered with restriction: Step therapy applies |
| quantity-limit | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Quantity limit applies | Covered with restriction: Quantity limit applies |
| pharmacy-restriction | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Pharmacy restriction applies | Covered with restriction: Pharmacy restriction applies |
| other-restriction | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Other restriction applies | Covered with restriction: Other restriction applies |
| not-covered | http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction | Not covered | Not covered |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |
IG © 2024+ HL7 International / Pharmacy. Package hl7.fhir.us.carin-rtpbc#2.0.0 based on FHIR 4.0.1. Generated 2025-08-07
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