Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot

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-ballot 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-01

Language: en

Profile: RTPBC Response Bundle

Bundle rtpbc-bundle-response-01 of type message

Entry 1 - fullUrl = http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-01

Resource MessageHeader:

> Language: en

> Profile: RTPBC Response MessageHeader

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

> ### Sources

> - | Name
> * | PharmacyBenefitsCompany

> ### Responses

> - | Identifier | Code
> * | rtpbc-messageheader-request-01 | OK

> focus: ClaimResponse: identifier = rtpbc-01-response; status = active; type = Pharmacy; use = predetermination; created = 2025-12-11 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-01

Resource ClaimResponse:

> Language: en

> Profile: RTPBC Response Using ClaimResponse

> identifier: rtpbc-01-response

> status: Active

> type: Pharmacy

> use: Predetermination

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

> created: 2025-12-11 11:20:59-0500

> insurer: Identifier: Pharmacy Plans US

> request: Identifier: rtpbc-01

> outcome: complete

> disposition: Processed successfully

> > item

> > RTPBC benefitRestriction Extension: RTPBC Benefit Restriction Code System (Temporary): prior-auth (Prior authorization required)

> > RTPBC formularyStatus Extension: NCPDP Formulary Status Code System (Temporary): O (On Formulary)

> > RTPBC preferenceLevel Extension: 2

> > RTPBC nextAvailableFillDate Extension: 2025-12-20

> > itemSequence: 1

> > > adjudication

> > > category: Copay

> > > ### Amounts

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

> > > adjudication

> > > category: Per prescription coinsurance

> > > ### Amounts

> > > - | Value | Currency
> > > * | 30 | USD

> > > adjudication

> > > category: Total patient responsibility

> > > ### Amounts

> > > - | Value | Currency
> > > * | 70 | USD

> > addItem

> > RTPBC isAlternative Extension: true

> > RTPBC benefitRestriction Extension: RTPBC Benefit Restriction Code System (Temporary): covered (Covered)

> > RTPBC formularyStatus Extension: NCPDP Formulary Status Code System (Temporary): P (On Formulary/Preferred)

> > RTPBC preferenceLevel Extension: 1

> > itemSequence: 1

> > provider: Organization My Mail Service Pharmacy

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

> > quantity: 180 {Each}

> > > adjudication

> > > category: Remaining deductible

> > > ### Amounts

> > > - | Value | Currency
> > > * | 305 | USD

> > > adjudication

> > > category: Per prescription coinsurance

> > > ### Amounts

> > > - | Value | Currency
> > > * | 30 | USD

> > > adjudication

> > > category: Total patient responsibility

> > > ### Amounts

> > > - | Value | Currency
> > > * | 70 | USD

Entry 3 - fullUrl = http://example.org/my-app/Patient/rtpbc-patient-01

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/Organization/rtpbc-organization-03m

Resource Organization:

> Language: en

> Profile: RTPBC Pharmacy Organization

> identifier: NCPDP Provider Identification Number/0999029

> active: true

> type: Mail Order

> name: My Mail Service Pharmacy

> ### Contacts

> - | Telecom | Address
> * | ph: 5551234567 | 10001 Oakland Road Milwaukee WI 54444 US