Real-Time Prescription Benefit for Provider Vendors Overview

Surescripts Real-Time Prescription Benefit for Provider Vendors 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 prescribers' 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 prescriber 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, prescribers and patients can make informed decisions that reduce payment obstacles and improve medication adherence.

The Surescripts Real-Time Prescription Benefit for Provider Vendors Companion Guide was created to assist provider vendors 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.

Please reference the following documents when reading this guide:

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.

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