Application Certification Requirements
RTPBRequest
S.201: Customers shall ensure all messages are syntactically correct before transmission to Surescripts.
PM.200: QuantityUnitOfMeasure Code Qualifiers shall be correctly associated with medication descriptions.
Note: Avoid using "Unspecified" for QuantityUnitOfMeasure in the request. If "Unspecified" is sent, the PBM may not be able to process and the response may result in an error.
RTPBResponse
S.200: Customers shall be able to receive syntactically valid maximum and minimum populated messages. Optional data elements (and values therein) shall not cause message failure.
Display Requirements
PM.201: During the prescription writing process and prior to sending the NewRx, the application shall display:
PM.202: The EstimatedPatientFinancialResponsibility, Quantity (element), and DaysSupply at requested pharmacy (first <PricingAndCoverages> element) for all medications returned (including alternatives).
PM.203: The EstimatedPatientFinancialResponsibility, Quantity (element), and DaysSupply at other pharmacies (subsequent <PricingAndCoverages> elements). This concession is allowed: An indicator that pricing at other pharmacies applies. User action on this indicator presents EstimatedPatientFinancialResponsibility, Quantity (element), and DaysSupply at other pharmacies in their entirety.
PM.204: Coverage restrictions for all <PricingAndCoverages> elements for medication combinations returned (including alternatives).
This concession is allowed: An indicator that coverage restriction(s) apply to a specific combination. User action on this indicator presents all coverage restrictions in their entirety.
Note: Coverage restrictions may be communicated in various coded and text fields, beyond the <CoverageRestriction> element, within the <PricingAndCoverage> element (i.e., <CoverageStatusCode>, <CoverageStatusMessage>).
PM.205: All available appropriate alternatives displayed together. If all alternatives cannot be shown together, this concession is allowed: An indicator that alternative medications are available. User interaction on this indicator presents all alternative medications together.
PM.206: User shall be made aware that the pricing/coverage data is a point in time calculation based upon data provided in the request and may vary once the prescription is filled at the dispensing pharmacy. Any returned alternative information is informational only and not intended to replace clinical decisions.
PM.207: Alternatives shall be displayed in the order provided from the PBM.
PM.208: Pricing information shall be displayed as returned in the RTPBResponse.
PM.209: The textual description of the codified value and not the CoverageRestrictionCode itself, shall be displayed to the user.
PM.210: The textual description of the codified value and not the CoverageStatusCode itself, shall be displayed to the user.
General Requirements
S.205: The sender shall ensure the combination of the From and MessageID elements, for all messages including Error, is unique for at least 18 months. Surescripts recommends an unformatted Globally Unique Identifier (GUID).
S.207: If an element does not have a value to be sent, the application shall not send any data. If no data is sent, the receiving application shall not display a value equal to zero, nor infer any value for that field.
Note: Placeholder values such as zero or N/A should not be sent.
S.208: Codified values within a message shall not conflict with the related textual concept.
S.209: The customer shall implement and maintain a Surescripts approved drug compendia that is updated at least monthly.
Note: Approved drug compendia for Real-Time Prescription Benefit include the following:
- Elsevier
- SCHOLZ DataBank
- First Databank (FDB)
- Oracle Health Multum
- Wolters Kluwer Medi-Span
- Merative (formerly IBM Truven Health Analytics)
- Or others as approved by Surescripts
S.210: Customers shall support the scenarios in the Message Linkage section of this guide.