CodeSystem-rtpbc-benefit-restriction

Sourcehl7.fhir.us.carin-rtpbc#1.0.0:Consumer Real-Time Pharmacy Benefit Check (v4.0.1)
resourceTypeCodeSystem
idrtpbc-benefit-restriction
canonicalhttp://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction
version1.0.0
statusactive
publisherHL7 International - Pharmacy
nameRtpbcBenefitRestrictionCodeSystem
titleRTPBC Benefit Restriction Code System
date2020-05-23T00:00:00-05:00
experimentalfalse
descriptionThis code system defines a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.
jurisdictionsus
caseSensitivefalse
contentcomplete
Usages

This case-insensitive code system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction defines the following codes:

Code Display Definition
covered Covered Covered
prior-auth Prior authorization required Covered with restriction: Prior authorization required
step-therapy Step therapy applies Covered with restriction: Step therapy applies
quantity-limit Quantity limit applies Covered with restriction: Quantity limit applies
pharmacy-restriction Pharmacy restriction applies Covered with restriction: Pharmacy restriction applies
other-restriction Other restriction applies Covered with restriction: Other restriction applies
not-covered Not covered Not covered

Produced 08 Sep 2023