PSS for CARIN Consumer-facing Real-time Pharmacy Benefit Check
1b. Project ID
1c. Is Your Project an Investigative Project (aka PSS-Lite)?
1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?
2a. Primary/Sponsor WG
2b. Co-Sponsor WG
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
2k. Conformance Facilitator
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
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.
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