Information displayed in the consumer realtime pharmacy benefit check must match the information displayed

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • US CARIN Real-time Pharmacy Benefit Check (RTPBC) (FHIR)
    • Pharmacy
    • Table of Contents
    • Scope of this guide
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      Resolution: Add guidance to clarify that responders must be consistent in the information it returns in provider-focused RTPB messaging (NCPDP) and consumer-focused RTPBC messaging defined in the FHIR IG.

      [The following to be included in a new Implementation Guidance page]:
      Consistency between implementations of consumer and provider-focused benefit check (NCPDP) processes
      When a party that has implemented the responder role of this implementation guide also has the ability to respond to provider-focused NCPDP Real-time Prescription Benefit (RTPB) transaction, it MUST ensure that it returns consistent values for information that is common between the two standards.

      While the consumer and provider exchanges each contain unique content for its audience, it is very important that information present in both is reported consistently to providers and patients--to support discussion between the patient and provider and to avoid confusion. For example, the total out of pocket cost returned for a given patient medication must be the same, whether reported by the consumer or provider messaging. And the the Coverage Summary information returned in the ClaimResponse .processNote as described in this guide must accurately summarize Patient Pay Component content returned in the NCPDP provider-focused RTPB transaction.

      This guide was designed to be compatible with the NCPDP RTPB transaction, using the same processing assumptions and information definitions wherever possible.

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      Resolution: Add guidance to clarify that responders must be consistent in the information it returns in provider-focused RTPB messaging (NCPDP) and consumer-focused RTPBC messaging defined in the FHIR IG. [The following to be included in a new Implementation Guidance page] : Consistency between implementations of consumer and provider-focused benefit check (NCPDP) processes When a party that has implemented the responder role of this implementation guide also has the ability to respond to provider-focused NCPDP Real-time Prescription Benefit (RTPB) transaction, it MUST ensure that it returns consistent values for information that is common between the two standards. While the consumer and provider exchanges each contain unique content for its audience, it is very important that information present in both is reported consistently to providers and patients--to support discussion between the patient and provider and to avoid confusion. For example, the total out of pocket cost returned for a given patient medication must be the same, whether reported by the consumer or provider messaging. And the the Coverage Summary information returned in the ClaimResponse .processNote as described in this guide must accurately summarize Patient Pay Component content returned in the NCPDP provider-focused RTPB transaction. This guide was designed to be compatible with the NCPDP RTPB transaction, using the same processing assumptions and information definitions wherever possible.
    • Scott Robertson / Frank McKinney : 15-0-0
    • Clarification
    • Non-substantive
    • 0.1.0

      (Not entirely sure where to include this, but I think recommending it be included in the scope is a good idea) While certain content in the provider-centric NCPDP RTPB standard will not be displayed in the patient-centric version, it is important that the information that IS presented in the patient-centric tool is consistent with the information that is shared by the provider-centric NCPDP standard based tools. Basically, important that the data is pulled from the same locations to ensure that the information the patient sees on the patient-centric tool matches what is presented by the provider-centric tool. If data presented by the patient RTPB tool contradicts what the prescriber sees in the EHR, this will cause considerable confusion and frustration and lead both physicians and patients to not trust the accuracy of RTPB technology. It is critical that NCPDP and HL7 closely coordinate RTPB efforts to ensure alignment of drug pricing data that is shared with prescribers and patients.

      Existing Wording:

      Relationship to the NCPDP provider-focused RTPBC transactions

      This initial release of the consumer RTPBC profile seeks to include the coverage and cost information that’s the most useful and meaningful to patients\. As a result, certain content in the provider-centric NCPDP RTPBC standard is not included here\. Additional content could potentially be added in a later effort\. (See Consumer vs provider RTPBC for content comparison\.)

            Assignee:
            Unassigned
            Reporter:
            Celine Lefebvre
            Celine Lefebvre
            Watchers:
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              Created:
              Updated:
              Resolved: