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-request-03

### Example RTPBC request scenario using FHIR messaging

In this example:

- the client is a patient application
- the server is the patient's insurer (specifically, the party that manages the patient's pharmacy benefit)
- the request is submitted as a Bundle containing a Claim and supporting resources, as the single parameter to the processor's $process-message operation

Content:

- the patient's name is Jane Doe, date of birth is 1975-12-05, and address is 100 Oak Court, Madison, WI 53510
- the requested medication is Prozac 10mg capsule, 60 capsules, for a 30 day supply (reflected in the Claim and MedicationRequest resources)
- the prescriber's identifying information is captured in the Practitioner resource
- the requested pharmacy is Hometown Drug (reflected in the Organization resource)
- the patient's coverage identifiers (BIN/PCN, member ID) are conveyed in a Coverage resource

The supporting data (patient, coverage, prescription, etc.) consists of identifying information that the processor will use to locate the patient's insurance record and coverage rules applying to the medication, pharmacy and prescriber.

Language: en

Profile: RTPBC Request Bundle

Bundle rtpbc-bundle-request-03 of type message

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

Resource MessageHeader:

> Language: en

> Profile: RTPBC Request MessageHeader

> event: RTPBC Event Type Code System: rtpbc-request (RTPBC Request)

> ### Sources

> - | Name
> * | MyPatientApp

> focus: Claim: identifier = rtpbc-03a; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:54-0500; priority = Normal

> definition: RTPBC Request Message Definition

Entry 2 - fullUrl = http://example.org/my-app/Claim/rtpbc-claim-03a

Resource Claim:

> Language: en

> Profile: RTPBC Request Using Claim

> identifier: rtpbc-03a

> status: Active

> type: Pharmacy

> use: Predetermination

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

> created: 2019-11-01 11:20:54-0500

> provider: Organization Hometown Drug

> priority: Normal

> prescription: MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01

> ### CareTeams

> - | Sequence | Provider
> * | 1 | Practitioner Johnson

> ### Insurances

> - | Sequence | Focal | Coverage
> * | 1 | true | Coverage: status = active; subscriberId = 121212; relationship = Self

> ### Items

> - | Sequence | CareTeamSequence | ProductOrService | Quantity
> * | 1 | 1 | fluoxetine 10 MG Oral Capsule [Prozac] | 60 {Each}

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

Resource Patient:

> Language: en

> Profile: RTPBC Patient

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

> Contact Detail | 100 Oak Court Madison WI 53510 US

Entry 4 - fullUrl = http://example.org/my-app/Coverage/rtpbc-coverage-01

Resource Coverage:

> Language: en

> Profile: RTPBC Coverage

> status: Active

> subscriberId: 121212

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

> relationship: Self

> > class

> > type: RX BIN

> > value: BIN001

> > class

> > type: RX PCN

> > value: PCN002

> > class

> > type: RX Group

> > value: GROUP0001

> > class

> > type: RX Id

> > value: MEMBER000001

Entry 5 - fullUrl = http://example.org/my-app/MedicationRequest/rtpbc-medicationrequest-03

Resource MedicationRequest:

> Language: en

> Profile: RTPBC Medication Request

> status: Draft

> intent: Proposal

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

> authoredOn: 2019-11-01

> requester: Practitioner Johnson

> ### DosageInstructions

> - | Text
> * | Take 2 capsules once a day

> > dispenseRequest

> > quantity: 60 {Each}

> > ### ExpectedSupplyDurations

> > - | Value | Unit | System | Code
> > * | 30 | days | http://unitsofmeasure.org | d

> ### Substitutions

> - | Allowed[x]
> * | false

Entry 6 - fullUrl = http://example.org/my-app/Practitioner/rtpbc-practitioner-03

Resource Practitioner:

> Language: en

> Profile: US Core Practitioner Profile

> identifier: United States National Provider Identifier/1234567893

> name: Johnson

Entry 7 - fullUrl = http://example.org/my-app/Organization/rtpbc-organization-03

Resource Organization:

> Language: en

> Profile: RTPBC Pharmacy Organization

> identifier: United States National Provider Identifier/9876543213

> active: true

> type: Retail

> name: Hometown Drug

> ### Contacts

> - | Telecom | Address
> * | ph: 6081234567 | 900 9th Street Madison WI 53535 US