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Submitting WG/Project/Implementer Group

 CARIN Alliance (PSS: Consumer-Facing RTPBC, Documents and Data for Connectathon)



Justification and Objectives

What’s the purpose of hosting this connectathon track? What do you hope to achieve?

The purpose of this track is to test the implementation approach for the patient-facing Real-Time Pharmacy Benefit Check that will allow consumers to access benefit and cash price information for their prescription medications.  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.


This track will use what version of FHIR.

This track will use version R4


Clinical input requested (if any)

None requested

Related tracks


(used to help guide seating arrangements and possibly drive track consolidation)

The target audience for Patient-Facing RTPBC development will include payer organizations who may also be involved in the various Da Vinci Tracks at the Connectathon.


Proposed Track Lead

Name, email. Track leads must be registered users on http://chat.fhir.org

Pooja Babbrah - pooja.babbrah@pocp.com


Expected participants

Participants please add/update your information in the track participant sheet


Track Orientation

A webinar will be hosted on date at time to share further participation information about this track.


System Roles

Describe each type of system that could participate in the track

Please include information here regarding how much advance preparation will be required if creating a client and/or server.


Role #1: Mobile Health Application

A mobile health application that can access and display a patients pharmacy benefit information for a specific medication (e.g., on/off formulary, out of pocket/copay, alternatives).

The mobile health application should also be able to display a cash price for the medication

 

Role #2: Prescription Cash or Discount Price Application

An application that can provide a discount or cash price for a specific medication.


Role #3: Pharmacy Benefit Manager or Payer

Pharmacy Benefit manager or Payer who can provide patient-level pharmacy benefit information including on/off formulary, out of pocket/copay, and covered alternatives



Scenarios

Describe the different scenarios participating systems can engage in during the conenctathon. Each scenario should provide sufficient description that participants can appropriately construct their software in advance to prepare to interoperate during the connectathon.


Mobile App will Retrieve Patient Level Pharmacy benefit information from a PBM/Payer and a discount/cash price for a specific medication.

Scenario Step 1 Send request for patient level pharmacy benefit information for a specific medication

Action: Requestor sends RTPBC request to PBM/Payer with mandatory fields (patient, insurance coverage, medication, pharmacy, prescriber) 

Precondition: Test patients loaded on FHIR server

Success Criteria: All required fields are sent to PBM/Payer and Payer sends affirmative response back to requestor

Scenario Step 2 Send request for a discount/cash price and potential pharmacy alternatives for a specific medication

Action:  Requestor sends RTPBC request to discount/cash price application/vendor with mandatory fields (medication, pharmacy, prescriber)

Precondition: Test patients loaded on FHIR server

Success Criteria: All required fields are sent to application/vendor and application/vendor sends affirmative response back to requestor

Scenario Step 3 Display benefit information, discount/cash price and potential alternative medications and potential alternative pharmacies for a specific medication

Action: Requestor receives information from PBM/Payer and discount/cash price vendor and displays information to the user

Precondition: Request to PBM/Payer and discount/cash price vendor is affirmative

Success Criteria: User can view information in the mobile app

TestScript(s)

Indicate any test scripts that will be used to help verify system behavior

Security and Privacy Considerations

Only test data and test accounts should be used for this, not individual devices or accounts.


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