Real-Time Prescription Benefit for Pharmacy Overview

this is early adopter documentation information is subject to change about real time prescription benefit for pharmacy surescripts real time prescription benefit (rtpb) for pharmacy is a real time request and response message between the pharmacy and pharmacy benefit manager (pbm) the rtpb message delivers patient specific medication cost and benefit information to pharmacists this may include point in time estimated cost, alternative medication options, 30 day supply cost, 90 day supply cost, patient out of pocket and deductible information, and coverage alerts rtpb data can be referenced before a claim has been adjudicated at the patient’s request or after the claim has been adjudicated if a high copay is returned or if the pharmacist wishes to avoid prior authorization rtpb provides value by saving pharmacy staff time, increasing staff and patient satisfaction, lowering health care costs, increasing speed to therapy, and improving health outcomes by providing accurate, up to date, patient specific information and cost effective medication options, pharmacists and patients can make informed decisions that reduce payment obstacles and improve medication adherence rtpb workflows this section includes high level overviews of how rtpb works within an optimized e prescribing workflow use cases of rtpb within a typical pharmacy workflow include on demand a pharmacy runs an rtpb at the patient’s request for any reason proactive a pharmacy automatically runs rtpb under certain circumstances, such as the following a copay is over a certain amount, a prescription is rejected because a prior authorization is required or the medication is not covered refills a pharmacy automatically runs rtpb after processing a claim for the prescription if the copay is above a certain threshold or is returned as drug not covered or prior authorization required about this document surescripts created this document to provide pharmacy customers information needed during implementation of rtpb for pharmacy messages and workflows the audience includes any customer responsible for configuring or developing a system interface for the electronic messages 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