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Source1

{
  "resourceType": "CodeSystem",
  "id": "rtpbc-formulary-status",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "phx"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 4,
      "_valueInteger": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
          }
        ]
      }
    },
    {
      "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"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-formulary-status",
  "version": "2.0.0",
  "name": "RtpbcFormularyStatusCodeSystem",
  "title": "RTPBC Formulary Status Code System",
  "status": "active",
  "experimental": false,
  "date": "2025-10-03T00:00:00-05:00",
  "publisher": "HL7 International / Pharmacy",
  "contact": [
    {
      "name": "HL7 International / Pharmacy",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/medication"
        }
      ]
    },
    {
      "name": "Frank McKinney",
      "telecom": [
        {
          "system": "email",
          "value": "fm@frankmckinney.com"
        }
      ]
    }
  ],
  "description": "This code system defines formulary statuses that may apply to a prescription product evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "caseSensitive": false,
  "content": "complete",
  "count": 9,
  "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"
    }
  ]
}