Real-Time Pharmacy Benefit Check (RTPBC)

Focus: Develop an implementation guide for the development of an API of real-time pharmacy benefit check for consumers that enables them to access their out of pocket costs, therapeutic alternatives, benefit and formulary information, and what their price would be if they paid cash.

Work in Development: The API implementation guide would also assist health plans to know when their member went off formulary and paid cash to improve the plan’s medication adherence quality scores. The implementation of the API would follow the Patient Right to Know Drug Prices Act from October 2018 and the proposed real-time benefit tool rule for Medicare Part D published in November 2018.
CARIN HL7® FHIR® IG for Consumer-facing Real-time Pharmacy Benefit Check
• Purpose: Published the CARIN FHIR IG for Consumer-facing Real-time Pharmacy Benefit Check within HL7 which includes membership ID card information

Please see below for several links to the CARIN Confluence website and the Zulip chats for the Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) and RTPBC IG.

CARIN Confluence page

CARIN Consumer-Facing Real-Time Pharmacy Benefit Check (RTPBC) Connectathon Track

Zulip chat Benefit Check IG