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 ClaimResponse: rtpbc-claim-response-03-price-source

Page standards status: Informative

### RTPBC ClaimResponse returned by a pricing source

In this example:

- the requested medication is Prozac 10mg capsule, 60 capsules, and the requested pharmacy is Hometown Drug. Adjudication is 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 referenced pharmacy Organization resource describes the alternative pharmacy option identified by the pricing source

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: Processing Complete

disposition: Processed successfully

> item

> itemSequence: 1

> noteNumber: 1

> > adjudication

> > category: Full product cash price

> > ### Amounts

> > - | Value | Currency
> > * | 105 | United States dollar

> > adjudication

> > category: Coupon discount amount

> > ### Amounts

> > - | Value | Currency
> > * | -20 | United States dollar

> > adjudication

> > category: Total patient responsibility

> > ### Amounts

> > - | Value | Currency
> > * | 85 | United States dollar

> 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 | United States dollar

> > adjudication

> > category: Coupon discount amount

> > ### Amounts

> > - | Value | Currency
> > * | -10 | United States dollar

> > adjudication

> > category: Total patient responsibility

> > ### Amounts

> > - | Value | Currency
> > * | 40 | United States dollar