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-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

-IdentifierCode
*rtpbc-messageheader-request-01OK

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:

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

-ValueCurrency
*40USD

adjudication

category: Per prescription coinsurance

Amounts

-ValueCurrency
*30USD

adjudication

category: Total patient responsibility

Amounts

-ValueCurrency
*70USD

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

-ValueCurrency
*305USD

adjudication

category: Per prescription coinsurance

Amounts

-ValueCurrency
*30USD

adjudication

category: Total patient responsibility

Amounts

-ValueCurrency
*70USD

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 Detail100 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

-TelecomAddress
*ph: 555123456710001 Oakland Road Milwaukee WI 54444 US