Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot United States of America flag

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-discount-card

Language: en

Profile: RTPBC Response Bundle Non-PHI

Bundle rtpbc-bundle-response-discount-card of type message

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

Resource MessageHeader:

event: RTPBC Event Type Code System: rtpbc-response-non-phi (RTPBC Non-PHI Response)

Sources

-Name
*GoodPricing

Responses

-IdentifierCode
*rtpbc-messageheader-request-non-phi-1OK

focus: ClaimResponse: identifier = rtpbc-03-response-discount-card; status = active; type = Pharmacy; use = predetermination; created = 2025-11-15 13:10:13-0500; outcome = complete; disposition = Processed successfully

definition: RTPBC Non-PHI Response Message Definition

Entry 2 - fullUrl = http://example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card

Resource ClaimResponse:

identifier: rtpbc-03-response-discount-card

status: Active

type: Pharmacy

use: Predetermination

patient: ?rref?

created: 2025-11-15 13:10:13-0500

insurer: ?rref?

request: Identifier: rtpbc-01

outcome: complete

disposition: Processed successfully

item

RTPBC relatedCoverage Extension: Coverage: status = active; subscriberId = ; relationship = Self

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

RTPBC relatedCoverage Extension: Coverage: status = active; subscriberId = ; relationship = Self

itemSequence: 1

productOrService: fluoxetine 10 MG Oral Capsule [Prozac]

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/Coverage/rtpbc-coverage-non-phi-01

Resource Coverage:

Language: en

Profile: RTPBC Coverage - Non-PHI

status: Active

subscriberId: ?ngen-9?

beneficiary: ?rref?

relationship: Self

class

type: RX BIN

value: BIN001

class

type: RX PCN

value: PCN002

class

type: RX Group

value: GROUP0001

class

type: RX Id

value: MEMBER000001