DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.0 - STU 2 United States of America flag

DaVinci Payer Data Exchange (PDex) US Drug Formulary, published by HL7 Pharmacy Working Group. This is not an authorized publication; it is the continuous build for version 2.0.0). 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: 2.0.0
Active as of 2022-08-25 Computable Name: CostShareOptionCS

Codes for qualifier of copay amount

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

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

CodeDisplayDefinition
after-deductible After DeductibleThe 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 DeductibleThe 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 ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductible No Charge After DeductibleThe 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 ChargeThe 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 ApplicableThe 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 ApplicableDeductible 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 WaivedThe consumer pays the cost share amount with deductible requirement waived.