Real-Time Prescription Benefit for PBM/Payers Overview

this is early adopter documentation information is subject to change note the term pbm/payer may include prescription benefit managers, third party processors, health plans, etc about surescripts real time prescription benefit surescripts real time prescription benefit is a real time request and response message between the provider vendor and the processor the real time prescription benefit message delivers patient specific medication cost and benefit information to the point of care to help inform prescription decisions this may include point in time estimated cost, alternative medication options, pharmacy type options, and formulary information real time prescription benefit data is referenced prior to the newrx to inform the provider and the patient of the specific estimated out of pocket cost for the selected therapy when available, real time prescription benefit is provided in addition to, and not a replacement of, the group/plan level formulary information real time prescription benefit provides value by driving medication adherence, lowering health care costs, and improving health outcomes and patient safety by providing accurate, up to date, patient specific information and cost effective medication options, providers and patients can make informed decisions that reduce payment obstacles and improve medication adherence about this guide the surescripts real time prescription benefit for pbm/payers companion guide was created to assist pbm/payers in implementing rtpbrequest and rtpbresponse messages the audience includes any customer responsible for configuring or developing a system interface for the electronic messages this guide is meant to support, integrate, and further clarify the ncpdp standard schemas, implementation guides, and best practices as used through the surescripts network it does not reproduce the base standard in its entirety requirements beyond those in the ncpdp documentation are called out in this guide and are also enforceable customers should read and comprehend the associated standards prior to reading this guide this guide only includes data elements where surescripts has specific requirements or further explains the field usage refer to the ncpdp rtpb xml schema for a complete list of fields and requirements document references please reference the following documents when reading this guide surescripts provided materials connectivity and authentication implementation guide https //docs surescripts com/connectivity authentication/guide eligibility companion guide https //docs surescripts com/eligibility/guide directory implementation guide (latest version) https //docs surescripts com/directory/guide external materials to be obtained by the customer (available at www ncpdp org http //www ncpdp org ) ncpdp rtpb v13 xml schema real time prescription benefit standard v13 implementation guide real time prescription benefit standard version 13 examples guide real time prescription benefit (rtpb) standard implementation recommendations ncpdp script this guide utilizes the ncpdp (national council for prescription drug programs) messaging standard prescriber/pharmacist interface script version 2023011 as a baseline to become an ncpdp member, please go to https //www ncpdp org/membership aspx https //www ncpdp org/membership aspx the ncpdp script standard 2023011 package contains a complete list of fields and additional requirements customers should read and comprehend the associated standards prior to reading this guide ncpdp is an american national standards institute (ansi) accredited standard development organization the ncpdp “script” standard is a copyrighted document and may be obtained by contacting ncpdp 9240 e raintree drive scottsdale, az 85260 7518 phone (480) 477 1000 fax (480) 767 1042 https //www ncpdp org https //www ncpdp org