Execute a Surescripts partnership agreement and complete the RTPB implementation guide review; obtain sandbox API credentials through the Surescripts developer portal
At the point of prescribing, send an RTPB request containing patient demographics (name, DOB, gender), proposed drug (NDC or RxNorm code), days supply, quantity, and preferred dispensing pharmacy NPI
Receive the RTPB response: parse PatientPayAmount (patient out-of-pocket cost), CoverageStatus (Covered/NotCovered/PriorAuthRequired), and AlternativeMedications array (up to 5 lower-cost covered alternatives with respective costs)
Display cost and coverage data inline in the prescribing workflow before the prescription is finalized; surface prior authorization flags so the prescriber can act before transmission
If PriorAuthRequired is returned, surface a link or workflow trigger to initiate NCPDP SCRIPT 2017071 ePA transactions or route to CoverMyMeds
Log each RTPB transaction ID and response timestamp for network reconciliation and payer audit requests
Known gotchas
RTPB response data is payer-provided and reflects the patient's current benefit at query time; plan design changes mid-year can cause stale cost estimates if the prescriber's system caches responses
Direct Surescripts integration requires a formal partnership agreement and certification process; EHR vendors may access RTPB through Surescripts network integrator partners rather than direct connection
RTPB does not guarantee claim approval; it reflects benefit design but the actual adjudicated amount at the pharmacy can differ if the patient has met or not met deductible since the last payer data refresh
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp