Consumer Real-Time Pharmacy Benefit Check
1.0.0 - STU1

This page is part of the Consumer Real-time Pharmacy Benefit Check (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example RTPBC Response Bundle

Format(s):

Example RTPBC response scenario using FHIR messaging

In this example:

  • the client is a patient application
  • the server is the patient's insurer (specifically, the party that manages the patient's pharmacy benefit)
  • the response is returned as a Bundle containing a ClaimResponse and supporting resources, in response to a $process-message operation

Content:

  • the requested medication is Prozac 10mg capsule, 60 capsules, and the requested pharmacy is Hometown Drug. Adjudication returned in the ClaimResponse.item composite
  • the .item contains patient costs for the requested drug and pharmacy combination
  • the .addItem composite holds an alternative fulfillment (the requested drug at a different pharmacy). Adjudication is returned in the ClaimResponse.addItem composite
  • a pharmacy Organization resource describes the alternative pharmacy option identified by the processor
  • benefit restriction information (e.g., Covered, Covered but requiring PA) is returned in the .benefitRestriction extensions in the .item and .addItem composites
bundle

Narrative view

Bundle rtpbc-bundle-response-03-w-header of type message

Entry 1 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0a

Resource MessageHeader:

Entry 2 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e3464805f0b

Resource ClaimResponse:

Entry 3 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0c

Resource Patient:

Entry 4 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0d

Resource Organization: