Messages Overview

message descriptions rtpbrequest the rtpbrequest message is used to request patient specific estimated cost and benefit information note the pharmacy ncpdpid from which the rtpbrequest is sent must be the same as that of the pharmacy for which estimated costs and benefit information is being requested rtpbresponse the rtpbresponse message returns patient specific estimated cost and benefit information, or the response may return business errors (e g , patientnotfound, drugnotfound etc ) the information contained in the rtpbresponse is dictated by the rtpbrequest workflow and content error this ncpdp script message indicates that an error has occurred and the rtpbrequest has been terminated an error can be generated when there is a communication problem or when the message had an error (e g , a formatting problem) transformation of messages to ensure a well formed message, surescripts will augment the rtpbrequest if the necessary ncpdp elements are not populated in certain instances, the rtpbresponse may also be altered rtpbrequest surescripts will add pbmmemberid and payerid to an rtpbrequest to allow a full real time prescription benefit transaction to occur these fields are filled out via a coverage lookup internal to surescripts any fields sent will be used as a way of determining which coverages to use if there are multiple coverages the benefit information that surescripts retrieves during the lookup process will not be displayed in the rtpbresponse the data for these fields filled in by the pharmacy system must be from the same source data can be taken from the newrx (recommended) or any other data stored in the pharmacy system that is less than 72 hours old the fields that are used in the coverage matching process are payerid pbmmemberid iin (issuer identification number) (extension based) pcn (processor identification number) (extension based) rtpbresponse surescripts will adjust the rtpbresponse by removing any medications that are passed in from the pbm that have a pharmacy ncpdpid that does not match the ncpdpid of the requesting pharmacy the remainder of the response remains consistent with the response sent from the pbm rtpb for pharmacy message flow successful rtpb message workflow scenario 1\ once the patient, medication, days supply, quantity, and quantity unit of measure have been selected, the pharmacist sends surescripts, via their pharmacy system, an rtpbrequest for the patient specific estimated cost and benefit data surescripts receives the rtpbrequest message 2\ if the benefitscoordination information is present in the message, surescripts forwards the rtpbrequest to the pbm/payer 2a) if the benefitscoordination information is not present, surescripts will look up the patient to retrieve the required data once obtained, surescripts will add the necessary information to the rtpbrequest that will be sent to the pbm/payer 3\ the pbm/payer processes the request, formats an rtpbresponse message with the patient specific estimated cost and benefit information and sends it to surescripts 4\ surescripts processes the message and returns the rtpbresponse synchronously to the pharmacy system note the rtpbresponse sent to the pharmacy system will not include coverage information obtained by surescripts message validation surescripts will ensure that customers are in compliance with the message specifications outlined in this guide during testing and will continue to enforce once in production at a minimum, surescripts validations include xml schema validation the sender identification and authentication the recipient identification syntax of the message, including field lengths, data types, and code values surescripts business rules note surescripts acrs are not enforced as part of validations, but instead through the certification process