{
  "description": "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. (A THO URL has been requested for this code system)",
  "_filename": "CodeSystem-rtpbc-benefit-restriction-temporary.json",
  "package_name": "hl7.fhir.us.carin-rtpbc",
  "date": "2026-03-01T00:00:00-05:00",
  "publisher": "HL7 International / Pharmacy",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "content": "complete",
  "name": "RtpbcBenefitRestrictionCodeSystem",
  "type": null,
  "experimental": "false",
  "resourceType": "CodeSystem",
  "title": "RTPBC Benefit Restriction Code System (Temporary)",
  "package_version": "2.0.0-ballot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 2
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "phx"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "trial-use",
    "_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": "active",
  "id": "777cabf3-6b47-4114-86d1-543f1f60273d",
  "kind": null,
  "count": 11,
  "url": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction-temporary",
  "concept": [ {
    "code": "covered",
    "display": "Covered",
    "definition": "Covered"
  }, {
    "code": "prior-auth",
    "display": "Prior authorization required",
    "definition": "Covered with restriction: Prior authorization required"
  }, {
    "code": "step-therapy",
    "display": "Step therapy applies",
    "definition": "Covered with restriction: Step therapy applies"
  }, {
    "code": "quantity-limit",
    "display": "Quantity limit applies",
    "definition": "Covered with restriction: Quantity limit applies"
  }, {
    "code": "pharmacy-restriction",
    "display": "Pharmacy restriction applies",
    "definition": "Covered with restriction: Pharmacy restriction applies"
  }, {
    "code": "other-restriction",
    "display": "Other restriction applies",
    "definition": "Covered with restriction: Other restriction applies"
  }, {
    "code": "not-covered",
    "display": "Not covered",
    "definition": "Not covered"
  }, {
    "code": "additional-fills-not-covered",
    "display": "Additional fills not covered",
    "definition": "Additional fills are not covered"
  }, {
    "code": "fill-too-soon",
    "display": "Fill too soon",
    "definition": "Fill too soon"
  }, {
    "code": "days-supply-limitation",
    "display": "Days supply limitation for product/service",
    "definition": "Days supply limitation for the product/service"
  }, {
    "code": "route-not-covered",
    "display": "Route of administration not covered",
    "definition": "Route of administration is not covered"
  } ],
  "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"
    } ]
  } ]
}