This is the proposed STU 2 version of the Consumer Real-Time Pharmacy Benefit Check FHIR IG for ballot in May 2026. It is sponsored by the HL7 Pharmacy Work Group
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Proposed path for this publication should usually be the canonical with the version or sequence appended and then some kind of label (typically '-snapshot')
A THO URL has been requested for this code system (https://jira.hl7.org/browse/UP-793)
INFORMATION: CodeSystem/rtpbc-benefit-restriction-temporary: CodeSystem: Most code systems defined in HL7 IGs will need to move to THO later during the process. Consider giving this code system a THO URL now (See https://confluence.hl7.org/display/TSMG/Terminology+Play+Book, and/or talk to TSMG) (1 uses)
Concepts from this code system are expected to be incorporated into the THO code system https://terminology.hl7.org/en/CodeSystem-adjudication.html at a future time
INFORMATION: CodeSystem/rtpbc-patient-pay-type-temporary: CodeSystem: Most code systems defined in HL7 IGs will need to move to THO later during the process. Consider giving this code system a THO URL now (See https://confluence.hl7.org/display/TSMG/Terminology+Play+Book, and/or talk to TSMG) (1 uses)
Examples for the MessageHeader profiles are within full request and response examples, because instances of these profiles are only valid in the context of referenced resources within the same Bundle. A link to a relevant full message example is present in the StructureDefinition page of each MessageHeader profile.
INFORMATION: StructureDefinition.where(url = 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader'): The Implementation Guide contains no explicitly linked examples for this profile (1 uses)
INFORMATION: StructureDefinition.where(url = 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader-non-phi'): The Implementation Guide contains no explicitly linked examples for this profile (1 uses)
INFORMATION: StructureDefinition.where(url = 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader'): The Implementation Guide contains no explicitly linked examples for this profile (1 uses)
INFORMATION: StructureDefinition.where(url = 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader-non-phi'): The Implementation Guide contains no explicitly linked examples for this profile (1 uses)
The RTPBC Non-PHI Coverage profile differs from the base RTPBC Coverage by requiring a Data Absent Reason extension in Coverage.beneficiary. A Coverage instance containing a Data Absent Reason in beneficiary is valid for both the Non-PHI profile and base profile... causing the IG Publisher to find multiple profile matches.
WARNING: Bundle/rtpbc-bundle-response-discount-card: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-discount-card*/.addItem[0].extension[1].value.ofType(Reference): Found multiple matching profiles for Coverage/rtpbc-coverage-non-phi-01 among choices: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage|2.0.0-ballot, http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage-non-phi|2.0.0-ballot (1 uses)
WARNING: Bundle/rtpbc-bundle-response-discount-card: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-discount-card*/.item[0].extension[0].value.ofType(Reference): Found multiple matching profiles for Coverage/rtpbc-coverage-non-phi-01 among choices: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage|2.0.0-ballot, http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage-non-phi|2.0.0-ballot (1 uses)
The SHALL, SHOULD and MAY statements flagged below are in narrative that defines what those terms mean
INFORMATION: en/conformance.html: The html source contains the word 'MAY' but it is not in a text phrase marked as a conformance clause: ' MAY describes optional behaviors that are free to consider but where there is no recommendation for or against adoption. ' (1 uses)
INFORMATION: en/conformance.html: The html source contains the word 'SHALL' but it is not in a text phrase marked as a conformance clause: ' SHALL indicates requirements that must be met to be conformant with the specification. ' (1 uses)
INFORMATION: en/conformance.html: The html source contains the word 'SHOULD' but it is not in a text phrase marked as a conformance clause: ' SHOULD indicates behaviors that ought to be adhered to to avoid suboptimal interoperability but which do not, for this version of the specification, affect the determination of specification conformance. ' (1 uses)
The pattern is set in a repeating slice. The pattern is expected to hold for all repetitions of that slice. (It's fixing the 'system' for the identifier.)
INFORMATION: StructureDefinition/rtpbc-pharmacy-organization: StructureDefinition.snapshot.element[18].pattern.ofType(Identifier): The repeating element has a pattern. The pattern will apply to all the repeats (this has not been clear to all users) (1 uses)
INFORMATION: StructureDefinition/rtpbc-pharmacy-organization: StructureDefinition.snapshot.element[27].pattern.ofType(Identifier): The repeating element has a pattern. The pattern will apply to all the repeats (this has not been clear to all users) (1 uses)
INFORMATION: StructureDefinition/rtpbc-pharmacy-organization: StructureDefinition.snapshot.element[36].pattern.ofType(Identifier): The repeating element has a pattern. The pattern will apply to all the repeats (this has not been clear to all users) (1 uses)
The warnings below are inherited from the US Core Organization profile on which rtpbc-pharmacy-organization is based. Below is the explanation provided in US Core v9: "US Core provides IG-specific guidance on interpreting Must Support for slices at `~/must-support.html#must-support---slices`. Where we state: "...the slicer's Must Support property only defines the element level Must Support/Additional USCDI property. In other words, the slicer's Must Support/Additional USCDI is not inherited by the slices, and each slice must be explicitly tagged with the Must Support/Additional USCDI property to define that slice's conformance strength. If no Must Support/Additional USCDI property is defined for the slice, this lengthy chat: https://chat.fhir.org/#narrow/channel/179252-IG-creation/topic/Slices.20not.20inheriting.20preferred.20bindings.20from.20root/with/514257770 and the resulting tracker FHIR-50391."
WARNING: StructureDefinition/rtpbc-pharmacy-organization: StructureDefinition.snapshot: The slice 'CLIA' on path 'Organization.identifier' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
WARNING: StructureDefinition/rtpbc-pharmacy-organization: StructureDefinition.snapshot: The slice 'NAIC' on path 'Organization.identifier' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
This IG's Non-PHI Claim and Non-PHI Coverage profiles exclude personally-identifiable information. The Claim.patient.display, Claim.insurance.coverage.display and Coverage.beneficiary.display elements are defined as 'not used' (0..0), to prevent use, making it impossible for the following examples to include display values.
WARNING: Bundle/rtpbc-bundle-request-non-phi-1: Bundle.entry[1].resource/*Claim/rtpbc-claim-non-phi-1*/.insurance[0].coverage: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-request-non-phi-1: Bundle.entry[1].resource/*Claim/rtpbc-claim-non-phi-1*/.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-request-non-phi-2: Bundle.entry[1].resource/*Claim/rtpbc-claim-non-phi-2*/.insurance[0].coverage: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-request-non-phi-2: Bundle.entry[1].resource/*Claim/rtpbc-claim-non-phi-2*/.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-response-discount-card: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-discount-card*/.insurer: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-response-discount-card: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-discount-card*/.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-response-discount-card: Bundle.entry[2].resource/*Coverage/rtpbc-coverage-non-phi-01*/.beneficiary: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-response-price-source: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-price-source*/.insurer: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Bundle/rtpbc-bundle-response-price-source: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-price-source*/.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Claim/rtpbc-claim-non-phi-1: Claim.insurance[0].coverage: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Claim/rtpbc-claim-non-phi-1: Claim.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Claim/rtpbc-claim-non-phi-2: Claim.insurance[0].coverage: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Claim/rtpbc-claim-non-phi-2: Claim.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: ClaimResponse/rtpbc-claim-response-discount-card: ClaimResponse.insurer: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: ClaimResponse/rtpbc-claim-response-discount-card: ClaimResponse.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: ClaimResponse/rtpbc-claim-response-price-source: ClaimResponse.insurer: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: ClaimResponse/rtpbc-claim-response-price-source: ClaimResponse.patient: A Reference without an actual reference or identifier should have a display (1 uses)
WARNING: Coverage/rtpbc-coverage-non-phi-01: Coverage.beneficiary: A Reference without an actual reference or identifier should have a display (1 uses)
This code system is specific to the message definitions defined in this guide. TSMG approved an exemption allowing the code system to remain in the IG. See TSMG minutes at https://confluence.hl7.org/spaces/TSMG/pages/441520556/2026-03-23+TSMG+Agenda+and+Minutes
INFORMATION: CodeSystem/rtpbc-event-type: CodeSystem: Most code systems defined in HL7 IGs will need to move to THO later during the process. Consider giving this code system a THO URL now (See https://confluence.hl7.org/display/TSMG/Terminology+Play+Book, and/or talk to TSMG) (1 uses)
This code system is temporary in this IG. Once the NCPDP Formulary Status code system is available in THO, the IG will be updated to use it instead of this temporary one. (HTA-169 Add NCPDP Formulary Status code system to HTA/THO)
INFORMATION: Bundle/rtpbc-bundle-response-01: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-01*/.addItem[0].extension[2].value.ofType(Coding): Reference to experimental CodeSystem http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary|2.0.0-ballot (1 uses)
INFORMATION: Bundle/rtpbc-bundle-response-01: Bundle.entry[1].resource/*ClaimResponse/rtpbc-claim-response-01*/.item[0].extension[1].value.ofType(Coding): Reference to experimental CodeSystem http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary|2.0.0-ballot (1 uses)
INFORMATION: ClaimResponse/rtpbc-claim-response-01: ClaimResponse.addItem[0].extension[2].value.ofType(Coding): Reference to experimental CodeSystem http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary|2.0.0-ballot (1 uses)
INFORMATION: ClaimResponse/rtpbc-claim-response-01: ClaimResponse.item[0].extension[1].value.ofType(Coding): Reference to experimental CodeSystem http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/ncpdp-formulary-status-temporary|2.0.0-ballot (1 uses)
INFORMATION: CodeSystem/ncpdp-formulary-status-temporary: CodeSystem: Most code systems defined in HL7 IGs will need to move to THO later during the process. Consider giving this code system a THO URL now (See https://confluence.hl7.org/display/TSMG/Terminology+Play+Book, and/or talk to TSMG) (1 uses)
This implementation guide uses external code systems which are listed in terminology.hl7.org (THO) but whose codes are not published by HL7
WARNING: Bundle/rtpbc-bundle-request-01: Bundle.entry[6].resource/*Organization/rtpbc-organization-01*/.type[0].coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the code cannot be validated (1 uses)
WARNING: Bundle/rtpbc-bundle-request-non-phi-2: Bundle.entry[2].resource/*Organization/rtpbc-organization-01*/.type[0].coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the code cannot be validated (1 uses)
WARNING: Bundle/rtpbc-bundle-response-01: Bundle.entry[3].resource/*Organization/rtpbc-organization-03m*/.type[0].coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the code cannot be validated (1 uses)
WARNING: Organization/rtpbc-organization-01: Organization.type[0].coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the code cannot be validated (1 uses)
WARNING: Organization/rtpbc-organization-02ps: Organization.type[0].coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the code cannot be validated (1 uses)
WARNING: Organization/rtpbc-organization-03m: Organization.type[0].coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the code cannot be validated (1 uses)
WARNING: ValueSet.where(id = 'rtpbc-error-code'): Error from https://tx.fhir.org/r4: Error: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPRejectCode' could not be found, so the value set cannot be expanded (2 uses)
WARNING: ValueSet.where(id = 'rtpbc-pharmacy-type'): Error from https://tx.fhir.org/r4: Error: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType' could not be found, so the value set cannot be expanded (2 uses)
This warning about the deprecated maxValueSet StuctureDefinition element is inherited from the US Core Coverage profile. The US Core QA indicates the issue is recognized and may be addressed in a future update
INFORMATION: StructureDefinition/rtpbc-coverage-non-phi: StructureDefinition.snapshot.element[4].binding.extension[0]: The extension http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet|5.2.0 is deprecated (1 uses)
This warning is inherited from the US Core Coverage profile. Below is the explanation provided in US Core v9: "These messages have been acknowledged for this release. After reviewing the implications for conformant systems and downstream publications, we will consider updating and/or adopting the recommended replacement in a future release."
INFORMATION: StructureDefinition/rtpbc-coverage-non-phi: StructureDefinition.snapshot.element[31].type[0].extension[1]: The extension http://hl7.org/fhir/StructureDefinition/regex|5.2.0 is deprecated with the note: 'This was deprecated in favor of using a constraint on the element using FHIRPath, since constraints allow for the provision of a human readable message associated with the regex' (1 uses)
hl7.fhir.us.carin-rtpbc
hl7.fhir.uv.extensions
