DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU 3 (ci-build) United States of America flag

DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pdex-formulary/ and changes regularly. See the Directory of published versions

CodeSystem: Codes qualifying the type of cost share amount

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE Version: 2.1.0
Standards status: Trial-use Computable Name: CostShareOptionCS

Codes for qualifier of copay amount

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

Generated Narrative: CodeSystem usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE

This case-sensitive code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE defines the following codes:

CodeDisplayDefinition
after-deductible After Deductible The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the cost-share amount (this indicates that this benefit is subject to the deductible).
before-deductible Before Deductible The consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).
no-charge No Charge No cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductible No Charge After Deductible The consumer first pays the deductible, and after the deductible is met, no cost share amount is charged (this indicates that this benefit is subject to the deductible).
charge Charge The consumer always pays just the cost share amount and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).
coinsurance-not-applicable Coinsurance Not Applicable The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs).
copay-not-applicable Copay Not Applicable Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.
deductible-waived Deductible Waived The consumer pays the cost share amount with deductible requirement waived.