| Package | hl7.fhir.us.carin-rtpbc |
| Resource Type | ImplementationGuide |
| Id | hl7.fhir.us.carin-rtpbc |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/us/carin-rtpbc/https://build.fhir.org/ig/HL7/carin-rtpbc/index.html |
| URL | http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc |
| Version | 2.0.0 |
| Status | active |
| Date | 2025-08-07T20:08:02+00:00 |
| Name | ConsumerRealTimePharmacyBenefitCheck |
| Title | Consumer Real-Time Pharmacy Benefit Check FHIR IG |
| Realm | us |
| Authority | hl7 |
| Description | FHIR Implementation Guide for Consumer Real-Time Pharmacy Benefit Check |
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Note: links and images are rebased to the (stated) source
Generated Narrative: ImplementationGuide hl7.fhir.us.carin-rtpbc
The official URL for this implementation guide is:
http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc
FHIR Implementation Guide for Consumer Real-Time Pharmacy Benefit Check
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},
"name": "RTPBC Benefit Restriction Code System",
"description": "This code system defines a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.",
"exampleBoolean": false
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"exampleBoolean": false
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"name": "RTPBC Event Type Value Set",
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"reference": {
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},
"name": "RTPBC isAlternative Extension",
"description": "This extension indicates that this added line item is to be interpreted as one of possibly multiple alternatives to the requested product or service. When isAlternative is true, the added line item is to be considered independently from any other added line items associated with the requested product or service.",
"exampleBoolean": false
},
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},
"name": "RTPBC Patient",
"description": "This profile constrains the Patient resource for carrying the limited patient information required in the consumer real-time pharmacy benefit check (RTPBC) process. \n\nThe profile differs from the US Core Patient profile in certain respects. It does not contain the us-core-race, us-core-ethnicity or us-core-birthsex extensions, and the Patient.communication.language and Patient.telecom elements are not set to Must Support; these variances reflects that clients in the exchange will typically be mobile consumer applications that do not posess this information, and that the information is not pertinent to this use case. \n\nThe RTPBC profile further constrains certain US Core and base elements in a manner that is compatible with the the US Core profile (e.g., tightening element cardinality and further limiting allowed terminology).",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CodeSystem"
}
],
"reference": {
"reference": "CodeSystem/rtpbc-patient-pay-type"
},
"name": "RTPBC Patient Pay Type Code System",
"description": "This code system defines components of a patient's responsibility for a prescription product's cost.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}
],
"reference": {
"reference": "ValueSet/rtpbc-patient-pay-type"
},
"name": "RTPBC Patient Pay Type Value Set",
"description": "This value set contains components of a patient's responsibility for a prescription product's cost.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-pharmacy-organization"
},
"name": "RTPBC Pharmacy Organization",
"description": "This profile builds on the US Core Organization to represent a pharmacy as used in the real-time pharmacy benefit check (RTPBC) process.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}
],
"reference": {
"reference": "ValueSet/rtpbc-pharmacy-type"
},
"name": "RTPBC Pharmacy Type Value Set",
"description": "This value set contains pharmacy type categories defined in the NCPDP Pharmacy Type (955-HR) code system.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}
],
"reference": {
"reference": "ValueSet/rtpbc-prescribable-product-code"
},
"name": "RTPBC Prescribable Product Code Value Set",
"description": "This value set includes codes used to specify prescribed medications in the US: RxNorm codes that specify drug name, strength and dose form (SBD, SCD, BPCK and GPCK term types) and NDC-11 codes (which represent specific packaged products).",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-request-bundle"
},
"name": "RTPBC Request Bundle",
"description": "This profile constrains a Bundle resource for use as the request in a Real-time Pharmacy Benefit Check (RTPBC) process",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MessageDefinition"
}
],
"reference": {
"reference": "MessageDefinition/rtpbc-request"
},
"name": "RTPBC Request Message Definition",
"description": "Request for patient cost and coverage information for a prescribed medication",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-request-messageheader"
},
"name": "RTPBC Request MessageHeader",
"description": "This profile constrains a MessageHeader resource for use in a Real-time Pharmacy Benefit Check (RTPBC) request bundle",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-request-claim"
},
"name": "RTPBC Request Using Claim",
"description": "This profile constrains the Claim resource so that it can serve as the RTPBC Request in the consumer real-time pharmacy benefit check process",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CapabilityStatement"
}
],
"reference": {
"reference": "CapabilityStatement/rtpbc-requester"
},
"name": "RTPBC Requester Capability Statement",
"description": "This CapabilityStatement describes the expected capabilities of a client system submitting a Real-time Pharmacy Benefit Check (RTPBC) request using the `$process-message` operation.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CapabilityStatement"
}
],
"reference": {
"reference": "CapabilityStatement/rtpbc-responder"
},
"name": "RTPBC Responder Capability Statement",
"description": "This CapabilityStatement describes the expected capabilities of a server that is capable of responding to a Real-time Pharmacy Benefit Check (RTPBC) request transacted with the `$process-message` operation.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-response-bundle"
},
"name": "RTPBC Response Bundle",
"description": "This profile constrains a Bundle resource for use as the response in a Real-time Pharmacy Benefit Check (RTPBC) process",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MessageDefinition"
}
],
"reference": {
"reference": "MessageDefinition/rtpbc-response"
},
"name": "RTPBC Response Message Definition",
"description": "Response to a request for patient cost and coverage information for a prescribed medication",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-response-messageheader"
},
"name": "RTPBC Response MessageHeader",
"description": "This profile constrains a MessageHeader resource for use in a Real-time Pharmacy Benefit Check (RTPBC) response bundle",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}
],
"reference": {
"reference": "StructureDefinition/rtpbc-response-claimresponse"
},
"name": "RTPBC Response Using ClaimResponse",
"description": "This profile constrains the ClaimResponse resource to serve as the RTPBC Response in the consumer real-time pharmacy benefit check process. It uses the ClaimResponse's \"predetermination\" processing mode",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}
],
"reference": {
"reference": "ValueSet/rtpbc-state-and-province-code"
},
"name": "RTPBC Two Letter State and Province Code Value Set",
"description": "This value set contains two letter USPS state codes and Canada Post province codes.",
"exampleBoolean": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}
],
"reference": {
"reference": "Bundle/rtpbc-bundle-request-03-price-source"
},
"name": "rtpbc-bundle-request-03-price-source",
"description": "An example RTPBC request bundle",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}
],
"reference": {
"reference": "Bundle/rtpbc-bundle-response-03-price-source"
},
"name": "rtpbc-bundle-response-03-price-source",
"description": "An example RTPBC response bundle produced by cash pricing source",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}
],
"reference": {
"reference": "Bundle/rtpbc-bundle-response-03-w-header"
},
"name": "rtpbc-bundle-response-03-w-header",
"description": "An example RTPBC response bundle produced by the patient's insurer",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Claim"
}
],
"reference": {
"reference": "Claim/rtpbc-claim-03"
},
"name": "rtpbc-claim-03",
"description": "An example of the primary RTPBC request resource (Claim)",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ClaimResponse"
}
],
"reference": {
"reference": "ClaimResponse/rtpbc-claim-response-03-price-source"
},
"name": "rtpbc-claim-response-03-price-source",
"description": "An example response from a cash pricing source (ClaimResponse)",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ClaimResponse"
}
],
"reference": {
"reference": "ClaimResponse/rtpbc-claim-response-03wh"
},
"name": "rtpbc-claim-response-03wh",
"description": "An example of the primary RTPBC response resource containing patient out-of-pocket cost, benefit restrictions and an alternative (ClaimResponse)",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ClaimResponse"
}
],
"reference": {
"reference": "ClaimResponse/rtpbc-claim-response-not-covered"
},
"name": "rtpbc-claim-response-not-covered",
"description": "This is an example of response stating that the requested drug is not covered",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Coverage"
}
],
"reference": {
"reference": "Coverage/rtpbc-coverage-01"
},
"name": "rtpbc-coverage-01",
"description": "An example RTPBC Coverage",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MedicationRequest"
}
],
"reference": {
"reference": "MedicationRequest/rtpbc-medicationrequest-03"
},
"name": "rtpbc-medicationrequest-03",
"description": "An example RTPBC MedicationRequest",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Organization"
}
],
"reference": {
"reference": "Organization/rtpbc-organization-03"
},
"name": "rtpbc-organization-03",
"description": "An example RTPBC pharmacy (Organization), representing a retail pharmacy",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Organization"
}
],
"reference": {
"reference": "Organization/rtpbc-organization-03ps"
},
"name": "rtpbc-organization-03ps",
"description": "An example RTPBC pharmacy",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Organization"
}
],
"reference": {
"reference": "Organization/rtpbc-organization-03wh"
},
"name": "rtpbc-organization-03wh",
"description": "An example of a mail service pharmacy",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Patient"
}
],
"reference": {
"reference": "Patient/rtpbc-patient-03"
},
"name": "rtpbc-patient-03",
"description": "An example RTPBC patient",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Patient"
}
],
"reference": {
"reference": "Patient/rtpbc-patient-03ps"
},
"name": "rtpbc-patient-03ps",
"description": "An example RTPBC patient with minimal content",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Patient"
}
],
"reference": {
"reference": "Patient/rtpbc-patient-03wh"
},
"name": "rtpbc-patient-03wh",
"description": "Example RTPBC patient",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Practitioner"
}
],
"reference": {
"reference": "Practitioner/rtpbc-practitioner-03"
},
"name": "rtpbc-practitioner-03",
"description": "An example US Core Practitioner",
"exampleBoolean": true
}
],
"page": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "toc.html"
}
],
"nameUrl": "toc.html",
"title": "Table of Contents",
"generation": "html",
"page": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "index.html"
}
],
"nameUrl": "index.html",
"title": "Home",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "business_rules.html"
}
],
"nameUrl": "business_rules.html",
"title": "Business Rules",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "capstatements.html"
}
],
"nameUrl": "capstatements.html",
"title": "Capstatements",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "consumer_vs_provider_rtpbc.html"
}
],
"nameUrl": "consumer_vs_provider_rtpbc.html",
"title": "Consumer vs Provider Rtpbc",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "downloads.html"
}
],
"nameUrl": "downloads.html",
"title": "Downloads",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "error_handling.html"
}
],
"nameUrl": "error_handling.html",
"title": "Error Handling",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "information_content_and_fhir_resources.html"
}
],
"nameUrl": "information_content_and_fhir_resources.html",
"title": "Information Content and Fhir Resources",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "logo.html"
}
],
"nameUrl": "logo.html",
"title": "Logo",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "other.html"
}
],
"nameUrl": "other.html",
"title": "Other",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "profiles.html"
}
],
"nameUrl": "profiles.html",
"title": "Profiles",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "security.html"
}
],
"nameUrl": "security.html",
"title": "Security",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "submission_method.html"
}
],
"nameUrl": "submission_method.html",
"title": "Submission Method",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "terminology.html"
}
],
"nameUrl": "terminology.html",
"title": "Terminology",
"generation": "markdown"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative"
},
{
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl": "use_cases.html"
}
],
"nameUrl": "use_cases.html",
"title": "Use Cases",
"generation": "markdown"
}
]
},
"parameter": [
{
"code": "path-resource",
"value": "input/capabilities"
},
{
"code": "path-resource",
"value": "input/examples"
},
{
"code": "path-resource",
"value": "input/extensions"
},
{
"code": "path-resource",
"value": "input/models"
},
{
"code": "path-resource",
"value": "input/operations"
},
{
"code": "path-resource",
"value": "input/profiles"
},
{
"code": "path-resource",
"value": "input/resources"
},
{
"code": "path-resource",
"value": "input/vocabulary"
},
{
"code": "path-resource",
"value": "input/maps"
},
{
"code": "path-resource",
"value": "input/testing"
},
{
"code": "path-resource",
"value": "input/history"
},
{
"code": "path-resource",
"value": "fsh-generated/resources"
},
{
"code": "path-pages",
"value": "template/config"
},
{
"code": "path-pages",
"value": "input/images"
},
{
"code": "path-tx-cache",
"value": "input-cache/txcache"
}
]
}
}