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 
Submission method
Note: The guide describes two methods for submitting the RTPBC request ($submit operation and FHIR® messaging using $process-message), with the intent to elicit comments from potential implementers.
(OPTION) Operation: $submit
The RTPBC request is submitted using the $submit operation on the processor’s claim server…
- URL: [base]/Claim/$submit
Submit parameter
The operation has a single FHIR® resource input parameter consisting of a Bundle containing the Claim resource and referenced supporting resources.
Request parameter bundle
- Claim - The main RTPBC request
- Patient - Patient-identifying information
- Coverage - Identifiers for the patient’s pharmacy insurance
- MedicationRequest - Key prescription information
- Practitioner - Prescriber-identifying information
- Organization - Identifying information for the preferred pharmacy
Example bundled RTPBC response from payer/PBM. Using $submit operation
Response bundle
- ClaimResponse - The main RTPBC response–containing pricing and coverage info
- Patient - Patient-identifying information echoed back from the request
- Organization - Identifying information for alternative pharmacies priced in the response. (0 or more)
Note: The Coverage, MedicationRequest, Practitioner and submitted pharmacy Organization resources are not echoed back in the response.
Example bundled RTPBC response from payer/PBM. Using $submit operation
(OPTION) Operation: $process-message
The RTPBC request is submitted using the $process-message operation on the processor’s claim server…
- URL: [base]/$process-message
Process-message parameter and response
Like the option above, the $process-message operation takes a single FHIR® resource input parameter consisting of a Bundle containing the Claim resource and referenced supporting resources, and returns a Bundle containing a ClaimResponse and supporting resources.
In addition, this method includes a MessageHeader resource in both the request and response.
- In the request, the MessageHeader’s focus.reference points to the Bundle’s Claim resource, per the CarinRtpbcRequestMessageDefinition.
- In the response, the focus.reference points to the Bundle’s ClaimResponse, per the CarinRtpbcResponseMessageDefinition.
