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

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: PROzac 10 MG Oral Capsule

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