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 in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

RTPBC Response from a pricing source

Format(s):

RTPBC ClaimResponse returned by a pricing source

In this example:

  • the requested medication is Prozac 10mg capsule, 60 capsules, and the requested pharmacy is Hometown Drug. Adjudication is 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 referenced pharmacy Organization resource describes the alternative pharmacy option identified by the pricing source
claimresponse

Narrative view

Generated Narrative

id: rtpbc-claim-response-03-price-source

meta:

identifier: id: rtpbc-03-response-price-source

status: active

type: Pharmacy

use: predetermination

patient: Generated Summary: id: rtpbc-patient-03; Patient internal identifier: 30455; Jane Doe ; gender: female; birthDate: 1975-12-05

created: Nov 1, 2019 4:20:59 PM

insurer:

request:

outcome: complete

disposition: Processed successfully

item

itemSequence: 1

noteNumber: 1

adjudication

category: Full product cash price

amount:

adjudication

category: Coupon discount amount

amount:

adjudication

category: Total patient responsibility

amount:

addItem

itemSequence: 1

provider: Generated Summary: id: rtpbc-organization-03m; id: 0999029; active; Mail Order; name: My Mail Service Pharmacy; ph: 5551234567

productOrService: PROzac 10 MG Oral Capsule

quantity: 60 {Each}

Adjudications

-CategoryAmount
*Full product cash price
*Coupon discount amount
*Total patient responsibility