- The following transactions need to be implemented for interoperability purposes:
- RTPB v13
- RTPBRequest, originated from the prescriber to request:
- patient eligibility
- product coverage
- benefit financials for a chosen product and pharmacy
- RTPBResponse, originated from the pharmacy benefit payers/processors to respond:
- To a RTPB request from a prescriber.
- This communication identifies coverage restrictions, and alternatives when they exist.
- Both the prescriber and the payer/processor/pharmacy benefits manager (PBM) must have their systems configured for these transactions to facilitate successful exchange, including the ability to send or receive status or error messages.
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- Secure Communication – Create a secure channel for client-to- serve and server-to-server communication.
- Secure Message Router – Securely route and enforce policy on inbound and outbound messages without interruption of delivery.
- Authentication Enforcer – Centralized authentication processes.
- Authorization Enforcer – Specifies access control policies.
- Credential Tokenizer – Encapsulate credentials as a security token for reuse (e.g., SAML, Kerberos).
- Assertion Builder – Define processing logic for identity, authorization and attribute statements.
- User Role – Identifies the role asserted by the individual initiating the transaction.
- Purpose of Use - Identifies the purpose for the transaction.
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