Consumer Real-Time Pharmacy Benefit Check FHIR IG
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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

rtpbc-bundle-response-03-price-source

Format(s):

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

Narrative view

Bundle rtpbc-bundle-response-03-price-source of type message

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

Resource MessageHeader:

event: RTPBC Event Type Code System rtpbc-response: RTPBC Response

Sources

-Name
*GoodPricing

Responses

-IdentifierCode
*rtpbc-messageheader-request-03OK

focus: Bundle: type = message; timestamp = 2019-11-15 13:10:15-0500

definition: RTPBC Response Message Definition

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

Resource 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

-ValueCurrency
*105USD

adjudication

category: Coupon discount amount

Amounts

-ValueCurrency
*-20USD

adjudication

category: Total patient responsibility

Amounts

-ValueCurrency
*85USD

addItem

RTPBC isAlternative Extension: true

itemSequence: 1

provider: Organization Home Drugs

productOrService: PROzac 10 MG Oral Capsule

quantity: 60 {Each}

adjudication

category: Full product cash price

Amounts

-ValueCurrency
*50USD

adjudication

category: Coupon discount amount

Amounts

-ValueCurrency
*-10USD

adjudication

category: Total patient responsibility

Amounts

-ValueCurrency
*40USD

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

Resource Patient:

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:

identifier: NCPDP Provider Identification Number/0999123

active: true

type: Retail

name: Home Drugs

Contacts

-TelecomAddress
*ph: 5556057672101 1st St N Minneapolis MN 55401