# NCPDP Formulary Status Code System (Temporary) - Consumer Real-Time Pharmacy Benefit Check FHIR IG v2.0.0-ballot

## CodeSystem: NCPDP Formulary Status Code System (Temporary) (Experimental) 

 
This code system defines formulary statuses that may apply to a prescription product evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process. (This code system is managed by NCPDP and is in the process of being listed in THO) 

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

* [RtbpcFormularyStatusValueSet](ValueSet-ncpdp-formulary-status.md)

-------

 [Description of the above table(s)](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#terminology). 



## Resource Content

```json
{
  "resourceType" : "CodeSystem",
  "id" : "ncpdp-formulary-status-temporary",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "phx"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "informative",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary",
  "version" : "2.0.0-ballot",
  "name" : "NCPDPFormularyStatusCodeSystem",
  "title" : "NCPDP Formulary Status Code System (Temporary)",
  "status" : "draft",
  "experimental" : true,
  "date" : "2025-10-03T00:00:00-05:00",
  "publisher" : "HL7 International / Pharmacy",
  "contact" : [{
    "name" : "HL7 International / Pharmacy",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/medication"
    }]
  },
  {
    "name" : "Frank McKinney",
    "telecom" : [{
      "system" : "email",
      "value" : "fm@frankmckinney.com"
    }]
  }],
  "description" : "This code system defines formulary statuses that may apply to a prescription product evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process. (This code system is managed by NCPDP and is in the process of being listed in THO)",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }]
  }],
  "caseSensitive" : false,
  "content" : "complete",
  "count" : 9,
  "concept" : [{
    "code" : "B",
    "display" : "Brand Preferred",
    "definition" : "Indicates the payer prefers the brand over the generic"
  },
  {
    "code" : "C",
    "display" : "Carve-Out",
    "definition" : "This medication is processed by a third party, not the payer providing the formulary"
  },
  {
    "code" : "N",
    "display" : "Non-Formulary",
    "definition" : "Response code indicating that the prescribed drug is not included in the plan formulary"
  },
  {
    "code" : "O",
    "display" : "On Formulary",
    "definition" : "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"
  },
  {
    "code" : "P",
    "display" : "On Formulary/Preferred",
    "definition" : "The medication is the preferred payable products in that patient's plan formulary"
  },
  {
    "code" : "U",
    "display" : "Unknown",
    "definition" : "Unknown"
  },
  {
    "code" : "X",
    "display" : "Non-Reimbursable without authorization",
    "definition" : "This medication is not covered although an exception or appeal process may exist"
  },
  {
    "code" : "Y",
    "display" : "Non-Reimbursable",
    "definition" : "The medication will never be reimbursable by the payer with no appeal process"
  },
  {
    "code" : "Z",
    "display" : "Zero Dollar Copay",
    "definition" : "This medication does not have a copay. The cost is $0 to the patient"
  }]
}

```
