During the August Work Group meetings, the DERF for the Real-Time Prescription Benefit Standard will be presented and voted on during the Maintenance and Control (MC) session on Thursday, August 8, 2019. MC is scheduled to meet 4:30 to 6:30 p.m. EDT.
This DERF is requesting the creation of a Real-Time Prescription Benefit Standard to meet the industry need within the pharmacy services sector to facilitate the ability for pharmacy benefit payers/processors to communicate to providers and to ensure a consistent implementation of the standard throughout the industry. The Standard enables the exchange of patient eligibility, product coverage, and benefit financials for a chosen product and pharmacy, and identifies coverage restrictions, and alternatives when they exist. The Standard will support two formats, EDI and XML, but will have a single implementation guide and common data content.
Please refer to and review DERF 001712 and its supporting documentation in preparation for this vote.