RTF (Real-Time Formulary) delivers plan level, formulary information to the prescriber at the point of care via a real-time Request and Response message. This service eliminates the need for the provider vendor to download large formulary files from Surescripts on a weekly basis. The data provided through RTF informs the prescriber of a medication's formulary status, payer-provided alternatives, coverage factors, and copay details. RTF data is intended to assist the prescriber in aligning their selected therapy with the patient’s benefit plan.
RTPB (Real-Time Prescription Benefit) is a real-time Request and Response message between the provider vendor and PBM. The RTPB message delivers patient-specific medication cost and benefit information to the point of care to help inform prescribers' prescription decisions. This includes point-in-time estimated cost, alternative medication options, pharmacy type options, and formulary information. RTPB data is referenced prior to the NewRx to inform the prescriber and the patient of the specific estimated out-of-pocket cost for the selected therapy. RTPB is provided in addition to, and not a replacement of, the group/plan level formulary information.
PrognoCIS provides extensive Formulary Information along with Prescription Benefit Information for a patient that would further help in prescribing drugs to the patient based on criterion selected. It is displayed under 2 tabs — RTF (Real Time Formulary) and RTPB (Real Time Prescription Benefit), such as:
RTF tab: This tab is used to display Real Time Formulary Information. When Drug, its strength and patient’s eligibility is selected from the Prescription screen of PrognoCIS, RTF request is sent to Surescripts. Real Time Formulary Information is received as response to this request and the same is populated in the RTF tab.
RTPB tab: This tab is used to display Real Time Prescription Benefit Information. When Drug, its strength, the Bulk quantity and its UOM (Unit of Measure), patient’s eligibility, and Pharmacy is selected from the Prescription screen of PrognoCIS, RTPB request is sent to Surescripts. Real Time Prescription Benefit Information is received as response to this request and the same is populated in RTPB tab, provided the payer should have the patient’s medication benefit check service available. RTF tab will also be populated, as the requirement of fetching RTF information (Drug, its strength and patient’s eligibility) is also fulfilled.
Formulary Information as well as Prescription Benefit Information is displayed in appropriate tab under the following sections:
- Drug Details: Details of the selected drug such as its Name, Reason, Rx-Norm, NDC, DEA class, quantity selected on Prescription screen before sending RTF/RTPB request, Free Text (additional information if available), Substitutions and Refill Quantity, etc. are displayed in the Drug Details section.
Note:
Drug Details are displayed on both RTF and RTPB tab.
- Copay Information: Copay information such as Pharmacy Type, Out Of Pocket Range, Copay Amount with Percent Rate, First Copay Term, Minimum and Maximum Copay Days, Copay Tier are displayed in the Copay Information section, in a tabular format.
Note:
Copay Information is not
displayed on RTPB tab.
- Coverage Information: Drug Coverage Information such as Pharmacy Name, Type and Address, NCPDP ID, NPI, selected Drug’s Status Code, its Formulary Status, whether Prior Authorization (PA) is required or not, quantity, Unit of Measure(UoM), Plan Payment Amount along with Patient Payment Amount, Coverage Alerts (if any) are displayed in the Coverage Information section, in a tabular format.
Note:
Coverage Information is displayed on both RTF and RTPB tab.
- Therapeutic Alternatives Information: The information of alternative drug that can be prescribed to the patient when Payer Specified Alternative is not available is displayed in this section, in a tabular format. Information such as Drug Name, Formulary Status, Preference Level, Copay Information (Pharmacy Type, Amount, %Rate, Copay Tier (Flat/Max)) is made available.
Note:
Therapeutic Alternatives Information is displayed on both RTF and RTPB tab.
