CARIN Consumer Realtime Pharmacy Benefit Check
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This page is part of the Consumer Real-time Pharmacy Benefit Check (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Example RTPBC ClaimResponse (the “RTPBC response”)

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 processor
  • summary coverage information (e.g., Covered, Covered but requiring PA) is returned in the .processNote element - linked to the particular item using the processNote.number field


claimresponse