Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot

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-ballot 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

## ValueSet: RTPBC Formulary Status Value Set

Official URL: http://hl7.org/fhir/us/carin-rtpbc/ValueSet/ncpdp-formulary-status | Version: 2.0.0-ballot | Highlight text changes?
Standards status: Trial-use Active as of 2025-10-03 | Maturity Level: 2 | Computable Name: RtbpcFormularyStatusValueSet

This value set contains formulary statuses that may apply to a prescription product evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.

References

- RTPBC formularyStatus Extension

### Logical Definition (CLD)

- Include all codes defined in `http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` version 📦2.0.0-ballot

### Expansion

Expansion performed internally based on codesystem NCPDP Formulary Status Code System (Temporary) v2.0.0-ballot (CodeSystem)

This value set contains 9 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | B | Brand Preferred | Indicates the payer prefers the brand over the generic |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | C | Carve-Out | This medication is processed by a third party, not the payer providing the formulary |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | N | Non-Formulary | Response code indicating that the prescribed drug is not included in the plan formulary |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | O | On Formulary | The medication submitted is included in the list of payable products in that patient's plan formulary but that there may be a more preferred product in the therapeutic category |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | P | On Formulary/Preferred | The medication is the preferred payable products in that patient's plan formulary |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | U | Unknown | Unknown |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | X | Non-Reimbursable without authorization | This medication is not covered although an exception or appeal process may exist |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | Y | Non-Reimbursable | The medication will never be reimbursable by the payer with no appeal process |  |
`http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary` | Z | Zero Dollar Copay | This medication does not have a copay. The cost is $0 to the patient |  |

Description of the above table(s).