The guide references using the FHIR claim resource. Our understanding is that this resource is similar to the X12 837P claim. Is this a valid resource to use for a process related to prescription drugs, for which the NCPDP Telecom standard is used for claims? Do pharmacy benefit managers (PBMs) use the FHIR claim resource? It is critical that PBMs be included in discussions about this guide to make sure that this will be a viable technology that can/will be used by the primary actors in this transaction.

It is critical that PBMs be included in discussions about this guide to make sure that this will be a viable technology that can/will be used by the primary actors in this transaction.

Existing Wording:

Resources used in the exchange

The consumer RTPBC request and response are accomplished using FHIR® Claim and ClaimResponse resources in a “predetermination” (what-if) mode\. Other FHIR® resources support the exchange by fleshing out patient, prescription, pharmacy and coverage information needed to determine accurate cost and coverage\. An OperationOutcome communicates exception situations where a ClaimResponse cannot be returned