DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 US

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

ValueSet: Qualifier for coinsurance rate

Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS Version: 2.1.0
Standards status: Trial-use Computable Name: CoinsuranceOptionVS
Other Identifiers: OID:2.25.74595174031514506193398850787025340071.48.2

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 version 📦2.1.0
    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

Expansion performed internally based on codesystem Codes qualifying the type of cost share amount v2.1.0 (CodeSystem)

This value set contains 6 concepts

SystemCodeDisplay (en)DefinitionJSONXML
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE  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).
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE  no-chargeNo ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE  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).
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE  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).
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE  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).
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE  deductible-waivedDeductible WaivedThe consumer pays the cost share amount with deductible requirement waived.

Description of the above table(s).