{
  "description": "This code system defines formulary statuses that may apply to a prescription product evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process. (This code system is managed by NCPDP and is in the process of being listed in THO)",
  "_filename": "CodeSystem-ncpdp-formulary-status-temporary.json",
  "package_name": "hl7.fhir.us.carin-rtpbc",
  "date": "2025-10-03T00:00:00-05:00",
  "publisher": "HL7 International / Pharmacy",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "content": "complete",
  "name": "NCPDPFormularyStatusCodeSystem",
  "type": null,
  "experimental": "true",
  "resourceType": "CodeSystem",
  "title": "NCPDP Formulary Status Code System (Temporary)",
  "package_version": "2.0.0-ballot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "phx"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "informative",
    "_valueCode": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical": "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
      } ]
    }
  } ],
  "status": "draft",
  "id": "4bad8c73-d439-4f54-a373-d303e883b5d0",
  "kind": null,
  "count": 9,
  "url": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary",
  "concept": [ {
    "code": "B",
    "display": "Brand Preferred",
    "definition": "Indicates the payer prefers the brand over the generic"
  }, {
    "code": "C",
    "display": "Carve-Out",
    "definition": "This medication is processed by a third party, not the payer providing the formulary"
  }, {
    "code": "N",
    "display": "Non-Formulary",
    "definition": "Response code indicating that the prescribed drug is not included in the plan formulary"
  }, {
    "code": "O",
    "display": "On Formulary",
    "definition": "The medication submitted is included in the list of payable products in that patient's plan formulary but that there may be a more preferred product in the therapeutic category"
  }, {
    "code": "P",
    "display": "On Formulary/Preferred",
    "definition": "The medication is the preferred payable products in that patient's plan formulary"
  }, {
    "code": "U",
    "display": "Unknown",
    "definition": "Unknown"
  }, {
    "code": "X",
    "display": "Non-Reimbursable without authorization",
    "definition": "This medication is not covered although an exception or appeal process may exist"
  }, {
    "code": "Y",
    "display": "Non-Reimbursable",
    "definition": "The medication will never be reimbursable by the payer with no appeal process"
  }, {
    "code": "Z",
    "display": "Zero Dollar Copay",
    "definition": "This medication does not have a copay. The cost is $0 to the patient"
  } ],
  "caseSensitive": false,
  "version": "2.0.0-ballot",
  "contact": [ {
    "name": "HL7 International / Pharmacy",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/medication",
      "system": "url"
    } ]
  }, {
    "name": "Frank McKinney",
    "telecom": [ {
      "value": "fm@frankmckinney.com",
      "system": "email"
    } ]
  } ]
}