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
: Qualifier for coinsurance rate - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:ValueSet ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "CoinsuranceOptionVS"] ; #
fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet CoinsuranceOptionVS</b></p><a name=\"CoinsuranceOptionVS\"> </a><a name=\"hcCoinsuranceOptionVS\"> </a><a name=\"CoinsuranceOptionVS-en-US\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html\"><code>http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-after-deductible\">after-deductible</a></td><td style=\"color: #cccccc\">After Deductible</td><td>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).</td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge\">no-charge</a></td><td style=\"color: #cccccc\">No Charge</td><td>No cost sharing is charged (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-no-charge-after-deductible\">no-charge-after-deductible</a></td><td style=\"color: #cccccc\">No Charge After Deductible</td><td>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).</td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-charge\">charge</a></td><td style=\"color: #cccccc\">Charge</td><td>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).</td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-coinsurance-not-applicable\">coinsurance-not-applicable</a></td><td style=\"color: #cccccc\">Coinsurance Not Applicable</td><td>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).</td></tr><tr><td><a href=\"CodeSystem-usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE.html#usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE-deductible-waived\">deductible-waived</a></td><td style=\"color: #cccccc\">Deductible Waived</td><td>The consumer pays the cost share amount with deductible requirement waived.</td></tr></table></li></ul></div>"
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "phx" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
fhir:v "trial-use" ;
( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary> ] ] ) ]
] ) ; #
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS"^^xsd:anyURI] ; #
fhir:version [ fhir:v "2.1.0"] ; #
fhir:name [ fhir:v "CoinsuranceOptionVS"] ; #
fhir:title [ fhir:v "Qualifier for coinsurance rate"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v "false"^^xsd:boolean] ; #
fhir:date [ fhir:v "2024-09-24T20:29:11+00:00"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "HL7 International / Pharmacy"] ; #
fhir:contact ( [
fhir:name [ fhir:v "HL7 International / Pharmacy" ] ;
( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/medication" ] ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "pharmacy@lists.HL7.org" ] ] )
] ) ; #
fhir:description [ fhir:v "Qualifier for coinsurance rate"] ; #
fhir:jurisdiction ( [
( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ] ] )
] ) ; #
fhir:compose [
( fhir:include [
fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE"^^xsd:anyURI ] ;
( fhir:concept [
fhir:code [ fhir:v "after-deductible" ] ] [
fhir:code [ fhir:v "no-charge" ] ] [
fhir:code [ fhir:v "no-charge-after-deductible" ] ] [
fhir:code [ fhir:v "charge" ] ] [
fhir:code [ fhir:v "coinsurance-not-applicable" ] ] [
fhir:code [ fhir:v "deductible-waived" ] ] ) ] )
] . #
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