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 the 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 the 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 as a replacement for, 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 the selected criteria. It is displayed under two 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 the Drug, its strength, and the patient's eligibility are selected from the Prescription Screen of PrognoCIS, an RTF request is sent to Surescripts. Real-Time Formulary Information is received in response to this request and is populated in the RTF Tab.
RTPB Tab: This tab is used to display Real-Time Prescription Benefit Information. When the Drug, its strength, the Bulk Quantity, and its UOM (Unit of Measure), the patient's eligibility, and the Pharmacy are selected from the Prescription Screen of PrognoCIS, an RTPB request is sent to Surescripts. Real-Time Prescription Benefit Information is received in response to this request and is populated in the RTPB Tab, provided the payer has the patient's medication benefit check service available. The RTF Tab will also be populated, as the requirement for fetching RTF information (the Drug, its strength, and the patient's eligibility) is also fulfilled.
Formulary Information as well as Prescription Benefit Information is displayed in the 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 the Prescription Screen before sending the 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 the RTF and RTPB Tabs.
- 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, and Copay Tier are displayed in the Copay Information section, in a tabular format.
Note:
Copay Information is not
displayed on the RTPB Tab.
- Coverage Information: Drug Coverage Information such as Pharmacy Name, Type and Address, NCPDP ID, NPI, the selected Drug's Status Code, its Formulary Status, whether Prior Authorization (PA) is required or not, the Quantity, Unit of Measure (UoM), Plan Payment Amount along with Patient Payment Amount, and Coverage Alerts (if any) are displayed in the Coverage Information section, in a tabular format.
Note:
Coverage Information is displayed on both the RTF and RTPB Tabs.
- Therapeutic Alternatives Information: The information for an alternative drug that can be prescribed to the patient when a Payer-Specified Alternative is not available is displayed in this section, in a tabular format. Information such as Drug Name, Formulary Status, Preference Level, and Copay Information (Pharmacy Type, Amount, %Rate, Copay Tier (Flat/Max)) is made available.
Note:
Therapeutic Alternatives Information is displayed on both the RTF and RTPB Tabs.