Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot
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
| Page standards status: Informative |
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: Processing 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 United States dollar adjudication
category: Per prescription coinsurance
Amounts
Value Currency 30 United States dollar adjudication
category: Total patient responsibility
Amounts
Value Currency 70 United States dollar
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 United States dollar adjudication
category: Per prescription coinsurance
Amounts
Value Currency 30 United States dollar adjudication
category: Total patient responsibility
Amounts
Value Currency 70 United States dollar
IG © 2020+ HL7 International / Pharmacy.
Package hl7.fhir.us.carin-rtpbc#2.0.0-ballot based on FHIR 4.0.1.
Generated
2026-03-31
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