RtpbcBenefitRestrictionCodeSystem

RTPBC Benefit Restriction Code System

activeCARIN RTPBC1.0.0complete7 concepts

This 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.

Metadata

hl7.org/fhir

Canonical URL: http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction
ID: rtpbc-benefit-restriction
Version: 1.0.0
Publisher: HL7 International - Pharmacy
Case Sensitive: No

Concepts (7)

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