Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot United States of America flag

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

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

Official URL: http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary Version: 2.0.0-ballot
Standards status: Informative Draft as of 2025-10-03 Computable Name: NCPDPFormularyStatusCodeSystem

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:

This case-insensitive code system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary defines the following codes:

CodeDisplayDefinition
B Brand Preferred Indicates the payer prefers the brand over the generic
C Carve-Out This medication is processed by a third party, not the payer providing the formulary
N Non-Formulary Response code indicating that the prescribed drug is not included in the plan formulary
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
P On Formulary/Preferred The medication is the preferred payable products in that patient's plan formulary
U Unknown Unknown
X Non-Reimbursable without authorization This medication is not covered although an exception or appeal process may exist
Y Non-Reimbursable The medication will never be reimbursable by the payer with no appeal process
Z Zero Dollar Copay This medication does not have a copay. The cost is $0 to the patient

Description of the above table(s).