CARIN Consumer-facing Real-time Pharmacy Benefit Check PSS


1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?	No
1e. Today's Date
1f. Name of standard being reaffirmed
1g. Project Artifact Information
1h. ISO/IEC Standard to Adopt
1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption?
1j. Unit of Measure
2a. Primary/Sponsor WG	Payer/Provider Information Exchange
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request formal content review prior to ballot
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Jean Duteau
2e. Other Interested Parties (and roles)
2f. Modeling Facilitator
2g. Publishing Facilitator	Pooja Babrah, Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2i. Domain Expert Representative
2j. Business Requirements Analyst
2k. Conformance Facilitator	Pooja Babbrah
2l. Other Facilitators
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
Attachments
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3g. Lineage
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Project
3j. Backwards Compatibility	No
3k. Additional Backwards Compatibility Information (if applicable)
3l. Using Current V3 Data Types?	N/A
3l. Reason for not using current V3 data types?
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
4d. Please define your New Product Definition
4d. Please define your New Product Family
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. White Paper Type
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Externally developed IG is to be (select one)
5a. Specify external organization	CARIN Alliance
5a. Revising Current Standard Info
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	Yes
5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval.	no
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6d. List Developers of Externally Developed Content
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6g. Other Vendors
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6h. Other Providers
6i. Realm	U.S. Realm Specific
7d. US Realm Approval Date	Jun 18, 2019
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7c. Co-Sponsor 2 Approval Date
7c. Co-Sponsor 3 Approval Date
7c. Co-Sponsor 4 Approval Date
7c. Co-Sponsor 5 Approval Date
7c. Co-Sponsor 6 Approval Date
7c. Co-Sponsor 7 Approval Date
7c. Co-Sponsor 8 Approval Date
7c. Co-Sponsor 9 Approval Date
7c. Co-Sponsor 10 Approval Date
7e. CDA MG Approval Date
7f. FMG Approval Date	May 29, 2019
7g. V2 MG Approval Date
7h. Architecture Review Board Approval Date
7i. Steering Division Approval Date	Jul 24, 2019
7j. TSC Approval Date	Sep 09, 2019

Show Changes

Version	6
Modifier	Anne Wizauer
Modify Date	Sep 10, 2019 18:44
1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?	No
2a. Primary/Sponsor WG	Pharmacy
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request formal content review prior to ballot
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Jean Duteau
2g. Publishing Facilitator	Pooja Babrah, Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2k. Conformance Facilitator	Pooja Babbrah
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Workgroup
3j. Backwards Compatibility	No
3l. Using Current V3 Data Types?	N/A
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Specify external organization	CARIN Alliance
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	Yes
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6i. Realm	U.S. Realm Specific
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7d. US Realm Approval Date	Jun 18, 2019
7f. FMG Approval Date	May 29, 2019
7i. Steering Division Approval Date	Jul 24, 2019
7j. TSC Approval Date	Sep 09, 2019

Version	5
Modifier	Anne Wizauer
Modify Date	Sep 06, 2019 20:09
1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?	No
2a. Primary/Sponsor WG	Pharmacy
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request formal content review prior to ballot
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Jean Duteau
2g. Publishing Facilitator	Pooja Babrah, Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2k. Conformance Facilitator	Pooja Babbrah
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Workgroup
3j. Backwards Compatibility	No
3l. Using Current V3 Data Types?	N/A
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Specify external organization	CARIN Alliance
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	Yes
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6i. Realm	U.S. Realm Specific
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7d. US Realm Approval Date	Jun 18, 2019
7f. FMG Approval Date	May 29, 2019
7i. Steering Division Approval Date	Jul 24, 2019

Version	4
Modifier	Anne Wizauer
Modify Date	Aug 27, 2019 18:34
1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?	No
2a. Primary/Sponsor WG	Pharmacy
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request formal content review prior to ballot
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Ryan Howells
2g. Publishing Facilitator	Pooja Babrah, Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2k. Conformance Facilitator	Pooja Babbrah
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Workgroup
3j. Backwards Compatibility	No
3l. Using Current V3 Data Types?	N/A
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Specify external organization	CARIN Alliance
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	Yes
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6i. Realm	U.S. Realm Specific
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7d. US Realm Approval Date	Jun 18, 2019
7f. FMG Approval Date	May 29, 2019
7i. Steering Division Approval Date	Jul 24, 2019

Version	3
Modifier	Ken McCaslin
Modify Date	Aug 20, 2019 23:51
1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?	No
2a. Primary/Sponsor WG	Pharmacy
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request formal content review prior to ballot
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Ryan Howells
2g. Publishing Facilitator	Pooja Babrah, Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2k. Conformance Facilitator	Pooja Babbrah
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Workgroup
3j. Backwards Compatibility	No
3l. Using Current V3 Data Types?	N/A
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Specify external organization	CARIN Alliance
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	No
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6i. Realm	U.S. Realm Specific
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7d. US Realm Approval Date	Jun 18, 2019
7f. FMG Approval Date	May 29, 2019
7i. Steering Division Approval Date	Jul 24, 2019

Version	2
Modifier	Anne Wizauer
Modify Date	Aug 19, 2019 15:28
1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?	No
2a. Primary/Sponsor WG	Pharmacy
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request formal content review prior to ballot
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Ryan Howells
2g. Publishing Facilitator	Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2k. Conformance Facilitator	Pooja Babbrah
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Workgroup
3j. Backwards Compatibility	No
3l. Using Current V3 Data Types?	N/A
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Specify external organization	CARIN Alliance
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	No
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6i. Realm	U.S. Realm Specific
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7d. US Realm Approval Date	Jun 18, 2019
7f. FMG Approval Date	May 29, 2019
7i. Steering Division Approval Date	Jul 24, 2019

Version	1
Modifier	Anne Wizauer
Modify Date	Aug 19, 2019 15:25
1a. Project Name	PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID	1543
1c. Is Your Project an Investigative Project (aka PSS-Lite)?	No
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?	No
2a. Primary/Sponsor WG	Pharmacy
2b. Co-Sponsor WG	Health Care Devices
2c. Co-Sponsor Level of Involvement	Request periodic project updates; specify period in text box below (e.g. 'Monthly', 'At WGMs', etc.)
2c. Co-Sponsor Update Periods	Periodic updates between meetings during interim calls and at WGMs
2d. Project Facilitator	Pooja Babbrah, Ryan Howells
2g. Publishing Facilitator	Paul Knapp
2h. Vocabulary Facilitator	Tim McNeil
2k. Conformance Facilitator	Pooja Babbrah
2m. Implementers	Humana, Cambia
3a. Project Scope	Develop a FHIR R4 based implementation guide for an API similar to the NCPDP Real-Time Pharmacy Benefit Check B2B standard that will allow consumers access to the same information as their providers including information related to their cash price. This information includes formulary and benefit information, OOP costs, therapeutic alternatives, and cash price through an API that would be accessible by the consumer through a third-party application.
3b. Project Need	The final Medicare Part D rule for 2020 (https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f#_Prohibition_Against_Gag) requires all Medicare Part D plans to send members information on lower cost therapeutic alternatives and requires the implementation of a real-time pharmacy benefit tool by 2021.
3c. Security Risk	No
3d. External Drivers	Final Medicare Part D rule for 2020
3e. Objectives/Deliverables and Target Dates	A FHIR R4 Implementation Guide The desired ballot is January 2020. Rough timeline 8/2019 - Draft implementation guide published 9/2019 - Connectathon 10/2019 - Development and Connectathon outcomes documented and presented to Pharmacy Work Group 11/2019 - Ballot material approved by Pharmacy Work Group 1/2020 - Ballot
3f. Common Names / Keywords / Aliases:	CARIN, RTPBC, RTBT, RTBC, real-time pharmacy benefit check
3h. Project Dependencies	None
3i. HL7-Managed Project Document Repository URL:	https://confluence.hl7.org/display/CAR/RTPBC+Workgroup
3j. Backwards Compatibility	No
3l. Using Current V3 Data Types?	N/A
3m. External Vocabularies	Yes
3n. List of Vocabularies	NCPDP Additional vocabularies to be added here
3o. Earliest prior release and/or version to which the compatibility applies	None
4a. Products	FHIR Extensions, FHIR Profiles, FHIR Resources
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?	R4
4c. FHIR Profiles Version	R4
5a. Project Intent	Implementation Guide (IG) will be created/modified
5a. Is the project adopting/endorsing an externally developed IG?	No
5a. Specify external organization	CARIN Alliance
5b. Project Ballot Type	STU to Normative
5c. Additional Ballot Info	January 2020 is the desired ballot date.
5d. Joint Copyright	No
6a. External Project Collaboration	CARIN Alliance
6b. Content Already Developed	0%
6c. Content externally developed?	No
6e. Is this a hosted (externally funded) project?	Yes
6f. Stakeholders	Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other
6f. Other Stakeholders	NCPDP, Consumer
6g. Vendors	Pharmaceutical, Health Care IT
6h. Providers	Healthcare Institutions (hospitals, long term care, home care, mental health)
6i. Realm	U.S. Realm Specific
7a. Management Group(s) to Review PSS	FHIR
7b. Sponsoring WG Approval Date	Jun 24, 2019
7c. Co-Sponsor Approval Date	Jul 02, 2019
7d. US Realm Approval Date	Jun 18, 2019
7f. FMG Approval Date	May 29, 2019
7i. Steering Division Approval Date	Jul 24, 2019

1a. Project Name
1b. Project ID	Assigned by the HL7 PMO via Project Insight
1c. Is Your Project an Investigative Project (aka PSS-Lite)?
1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?	(Includes Reaffirmations)
1e. Today's Date
1f. Name of standard being reaffirmed	Please review the Master Standards Grid and copy/paste the exact name of the standard
1g. Project Artifact Information
1h. ISO/IEC Standard to Adopt
1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption?
1j. Unit of Measure
2a. Primary/Sponsor WG	Work Groups formed in 2019 or later are located at the bottom of the dropdown.
2b. Co-Sponsor WG	Work Groups formed in 2019 or later are located at the bottom of the dropdown.
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 2
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 2 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 3
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 3 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 4
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 4 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 5
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 5 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 6
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 6 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 7
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 7 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 8
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 8 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 9
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 9 Update Periods	(Monthly, at WGMs, etc)
2b. Co-Sponsor WG 10
2c. Co-Sponsor Level of Involvement	Start typing to get list of options (supports multiple selection)
2c. Co-Sponsor Involvement
2c. Co-Sponsor 10 Update Periods	(Monthly, at WGMs, etc)
2d. Project Facilitator
2e. Other Interested Parties (and roles)
2f. Modeling Facilitator
2g. Publishing Facilitator	(Required if balloting in the same cycle as PSS submission)
2h. Vocabulary Facilitator
2i. Domain Expert Representative
2j. Business Requirements Analyst
2k. Conformance Facilitator	(Required for Implementation Guide projects)
2l. Other Facilitators	(e.g. SOA, etc)
2m. Implementers	(Two Required for STU Projects)
3a. Project Scope
Attachments
3b. Project Need
3c. Security Risk
3d. External Drivers
3e. Objectives/Deliverables and Target Dates	Append date to each listed. Target Dates can be in WGM/Ballot Cycle format; ex: January 2020 Ballot or May 2020 WGM
3f. Common Names / Keywords / Aliases:
3g. Lineage
3h. Project Dependencies
3i. HL7-Managed Project Document Repository URL:	Required for TSC approval
3j. Backwards Compatibility
3k. Additional Backwards Compatibility Information (if applicable)
3l. Using Current V3 Data Types?
3l. Reason for not using current V3 data types?
3m. External Vocabularies
3n. List of Vocabularies
3o. Earliest prior release and/or version to which the compatibility applies
4a. Products	Arden Syntax Clinical Information Modeling Initiative (CIMI) Clinical Context Object Workgroup (CCOW) Domain Analysis Model (DAM) Electronic Health Record (EHR) Functional Profile FHIR Extensions FHIR Implementation Guide FHIR Profiles FHIR Resources Guidance (e.g. Companion Guide, Cookbook, etc) Logical Model New/Modified/HL7 Policy/Procedure/Process New Product Definition New Product Family Non Product Project - (Educ. Marketing, Elec. Services, etc.) White Paper Creating/Using a tool not listed in the HL7 Tool Inventory V2 Messages – Administrative V2 Messages - Clinical V2 Messages - Departmental V2 Messages – Infrastructure V3 Domain Information Model (DIM / DMIM) V3 Documents – Administrative (e.g. SPL) V3 Documents – Clinical (e.g. CDA) V3 Documents - Knowledge V3 Foundation – RIM V3 Foundation – Vocab Domains & Value Sets V3 Messages - Administrative V3 Messages - Clinical V3 Messages - Departmental V3 Messages - Infrastructure V3 Rules - GELLO V3 Services – Java Services (ITS Work Group) V3 Services – Web Services (SOA)
4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?
4c. FHIR Profiles Version
4d. Please define your New Product Definition
4d. Please define your New Product Family
5a. Project Intent	Create new standard Revise current standard Reaffirmation of a standard New/Modified HL7 Policy/Procedure/Process White Paper Supplement to a current standard Implementation Guide (IG) will be created/modified N/A (Project not directly related to an HL7 Standard)
5a. White Paper Type
5a. Is the project adopting/endorsing an externally developed IG?
5a. Externally developed IG is to be (select one)
5a. Specify external organization
5a. Revising Current Standard Info	Name of the standard being revised Date it was published (or request for publication, or ANSI designation date) Rationale for revision The relationship between the new standard and the current standard (is it designed to replace the current standard, a supplement to the current standard, etc.)
5b. Project Ballot Type	Comment (aka Comment-Only) Informative STU to Normative Normative (no STU) Joint Ballot (with other SDOs) Withdrawal N/A (project won’t go through ballot)
5c. Additional Ballot Info	If necessary, add any additional ballot information here
5d. Joint Copyright	Joint Copyrighted Material will be produced?
5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval.
6a. External Project Collaboration	Include SDOs or other external entities you are collaborating with, including government agencies as well as any industry outreach. Indicate the nature and status of the Memorandum of Understanding (MOU) if applicable
6b. Content Already Developed	How much content for this project is already developed? Indicate %
6c. Content externally developed?	See ARB Guideline for External Content Submission
6d. List Developers of Externally Developed Content
6e. Is this a hosted (externally funded) project?
6f. Stakeholders	Clinical and Public Health Laboratories Immunization Registries Quality Reporting Agencies Regulatory Agency Standards Development Organizations (SDOs) Payors N/A Other
6f. Other Stakeholders
6g. Vendors	Pharmaceutical EHR, PHR Equipment Health Care IT Clinical Decision Support Systems Lab HIS N/A Other
6g. Other Vendors
6h. Providers	Clinical and Public Health Laboratories Emergency Services Local and State Departments of Health Medical Imaging Service Healthcare Institutions (hospitals, long term care, home care, mental health) N/A Other
6h. Other Providers
6i. Realm
7a. Management Group(s) to Review PSS	CDA FHIR V2
7b. Sponsoring WG Approval Date
7c. Co-Sponsor Approval Date
7c. Co-Sponsor 2 Approval Date
7c. Co-Sponsor 3 Approval Date
7c. Co-Sponsor 4 Approval Date
7c. Co-Sponsor 5 Approval Date
7c. Co-Sponsor 6 Approval Date
7c. Co-Sponsor 7 Approval Date
7c. Co-Sponsor 8 Approval Date
7c. Co-Sponsor 9 Approval Date
7c. Co-Sponsor 10 Approval Date
7d. US Realm Approval Date
7e. CDA MG Approval Date
7f. FMG Approval Date
7g. V2 MG Approval Date
7h. Architecture Review Board Approval Date
7i. Steering Division Approval Date
7j. TSC Approval Date




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