×

To enhance security, Multi-Factor Authentication (MFA) is mandatory for all HL7 users. More information

 

CARIN Consumer-facing Real-time Pharmacy Benefit Check (PSS in Confluence)

Basics

CARIN Consumer-facing Real-time Pharmacy Benefit Check (PSS in Confluence)

1543
Ballot - STU to Normative


FHIR Profile

Implementation Guide

Details

Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.


The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.



A FHIR R4 Implementation Guide


https://confluence.hl7.org/display/ADDC/PSS+for+CARIN+Consumer-facing+Real-time+Pharmacy+Benefit+Check

CARIN Alliance


Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other (specify in Misc. Notes below),Healthcare Institutions (hospitals, long term care, home care, mental health),Pharmaceutical; Health Care IT

Humana, Cambia

Final Medicare Part D rule for 2020

RTPBC, RTBT, RTBC


Yes


No

2023 October: TSC approved STU Extension Request for HL7 FHIR Implementation Guide: Consumer-facing Real-time Pharmacy Benefit Check, Release 1 - US Realm for 2 years 2022 April: TSC approved STU Extension Request for CARIN Consumer-facing Real-time Pharmacy Benefit Check for 2 years 2022 February: TSC approved STU Extension Request for CARIN Consumer-facing Real-time Pharmacy Benefit Check for 2 years 2020 July: TSC approved STU Publication Request for Consumer-facing Real time Pharmacy Benefit Check for two years Other Stakeholders: NCPDP, Consumer
Organization & Realm

Realm Specific - US

U.S.
People

Pooja Babbrah, Ryan Howells



Pharmacy Work Group

Pharmacy Work Group

Status & Dates

Active

STU - Reconcile

06/24/2019

01/01/2029

2029 Jan WGM/Ballot

05/15/2028

2028 May WGM/Ballot

2026 MAY Ballot Cycle Info: STU Ballot Results: Met basic vote requirements. 0 Negatives to reconcile Document Name:HL7 FHIR® Implementation Guide: Consumer-facing Real-time Pharmacy Benefit Check, Release 1- US Realm 2020 Feb Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 17 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Consumer-facing Real-time Pharmacy Benefit Check, Release 1- US Realm
Approvals

09/09/2019


Received


Received




System Info






06/25/2026

Anne Wizauer