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
| Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CopayOptionVS | Version: 2.1.0 | ||||
| Standards status: Trial-use | Computable Name: CopayOptionVS | ||||
| Other Identifiers: OID:2.25.74595174031514506193398850787025340071.48.3 | |||||
Qualifier of copay amount
References
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE version 📦2.1.0| Code | Display | Definition |
| 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). |
| 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. |
Expansion performed internally based on codesystem Codes qualifying the type of cost share amount v2.1.0 (CodeSystem)
This value set contains 7 concepts
| System | Code | Display (en) | Definition | JSON | XML |
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE | 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). | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE | 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). | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE | no-charge | No Charge | No 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-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). | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE | 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). | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE | 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'. | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE | deductible-waived | Deductible Waived | The consumer pays the cost share amount with deductible requirement waived. |