Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build

Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions

## Example Bundle: rtpbc-bundle-response-price-source

### RTPBC response bundle returned by a pricing source

In this example:

- the client is a patient application
- the server is a medication pricing source vendor
- the response is returned as a Bundle containing a ClaimResponse and supporting resources, in response to a $process-message operation

Content:

- the requested medication is Prozac 10mg capsule, 60 capsules, and the requested pharmacy is Hometown Drug. Adjudication returned in the ClaimResponse.item composite
- the .item contains patient costs for the requested drug and pharmacy combination
- the .addItem composite holds an alternative fulfillment (the requested drug at a different pharmacy). Adjudication is returned in the ClaimResponse.addItem composite
- a pharmacy Organization resource describes the alternative pharmacy option identified by the processor

Language: en

Profile: RTPBC Response Bundle

Bundle rtpbc-bundle-response-price-source of type message

Entry 1 - fullUrl = http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-03ps

Resource MessageHeader:

> Language: en

> Profile: RTPBC Response MessageHeader

> event: RTPBC Event Type Code System: rtpbc-response (RTPBC Response)

> ### Sources

> - | Name
> * | GoodPricing

> ### Responses

> - | Identifier | Code
> * | rtpbc-messageheader-request-03 | OK

> focus: ClaimResponse: identifier = rtpbc-03-response-price-source; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:59-0500; outcome = complete; disposition = Processed successfully

> definition: RTPBC Response Message Definition

Entry 2 - fullUrl = http://example.org/my-app/ClaimResponse/rtpbc-claim-response-03-price-source

Resource ClaimResponse:

> Language: en

> Profile: RTPBC Response Using ClaimResponse

> identifier: rtpbc-03-response-price-source

> status: Active

> type: Pharmacy

> use: Predetermination

> patient: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

> created: 2019-11-01 11:20:59-0500

> insurer: Identifier: GoodPricing

> request: Identifier: rtpbc-03

> outcome: complete

> disposition: Processed successfully

> > item

> > itemSequence: 1

> > noteNumber: 1

> > > adjudication

> > > category: Full product cash price

> > > ### Amounts

> > > - | Value | Currency
> > > * | 105 | USD

> > > adjudication

> > > category: Coupon discount amount

> > > ### Amounts

> > > - | Value | Currency
> > > * | -20 | USD

> > > adjudication

> > > category: Total patient responsibility

> > > ### Amounts

> > > - | Value | Currency
> > > * | 85 | USD

> > addItem

> > RTPBC isAlternative Extension: true

> > itemSequence: 1

> > provider: Organization Home Drugs

> > productOrService: fluoxetine 10 MG Oral Capsule [Prozac]

> > quantity: 60 {Each}

> > > adjudication

> > > category: Full product cash price

> > > ### Amounts

> > > - | Value | Currency
> > > * | 50 | USD

> > > adjudication

> > > category: Coupon discount amount

> > > ### Amounts

> > > - | Value | Currency
> > > * | -10 | USD

> > > adjudication

> > > category: Total patient responsibility

> > > ### Amounts

> > > - | Value | Currency
> > > * | 40 | USD

Entry 3 - fullUrl = http://example.org/my-app/Patient/rtpbc-patient-03ps

Resource Patient:

> Language: en

> Profile: RTPBC Patient

> Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

Entry 4 - fullUrl = http://example.org/my-app/Organization/rtpbc-organization-03ps

Resource Organization:

> Language: en

> Profile: RTPBC Pharmacy Organization

> identifier: NCPDP Provider Identification Number/0999123

> active: true

> type: Retail

> name: Home Drugs

> ### Contacts

> - | Telecom | Address
> * | ph: 5556057672 | 101 1st St N Minneapolis MN 55401