CARIN Consumer-Facing Real-Time Pharmacy Benefit Check (PSS-2687)

Develop a FHIR implementation guide enabling consumers to use a FHIR-enabled app to learn the cost, insurance coverage and related information for medications they've been prescribed. Specifically…

• how a medication will be covered by their insurance, including out of pocket costs and any coverage restrictions or requirements that might apply
• cash and discount pricing available for the medication
• available patient assistance programs and other information related to the medication

The sources of this information may include the patient's insurance company (and/or its pharmacy benefit manager), providers of medication pricing information, manufacturers or other facilitating entities.

This specification is, in part, an adaptation of the existing NCPDP Real-time Prescription Benefit (RTPB) standard which is designed for use between provider systems and payers. This consumer-facing IG intends to enable consumers to access information that is consistent with what is available to their providers through the NCPDP standard--while also providing cash/discount pricing and related information of interest to patients.

(Note: This PSS replaces the original 2019 PSS captured in Confluence)