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 of copay amount

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

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).
    before-deductibleBefore 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-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).
    copay-not-applicableCopay 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-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 7 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  before-deductibleBefore 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).
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  copay-not-applicableCopay 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'.
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).