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

ValueSet: Qualifier for coinsurance rate

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS Version: 2.0.0
Active as of 2022-08-25 Computable Name: CoinsuranceOptionVS

Qualifier for coinsurance rate

References

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE
    CodeDisplayDefinition
    after-deductibleAfter 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).
    no-chargeNo ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
    no-charge-after-deductibleNo 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).
    chargeChargeThe 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-applicableCoinsurance 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).
    deductible-waivedDeductible WaivedThe consumer pays the cost share amount with deductible requirement waived.

 

Expansion

This value set contains 6 concepts

Expansion based on Codes qualifying the type of cost share amount v2.0.0 (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE

CodeDisplayDefinition
  after-deductibleAfter 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).
  no-chargeNo ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
  no-charge-after-deductibleNo 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).
  chargeChargeThe 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-applicableCoinsurance 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).
  deductible-waivedDeductible WaivedThe consumer pays the cost share amount with deductible requirement waived.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code