POCP Prescription Enrollment
0.1.0 - CI Build US

POCP Prescription Enrollment - Local Development build (v0.1.0). See the Directory of published versions

Use Cases and Roles

The exchanges described in this implementation guide support specialty medication enrollment through the sharing of information between a prescriber of a specialty medication and those involved in fulfilling it and supporting the patient. This section describes the participants in those exchanges and the particular scenarios defined in the guide.

Human Roles

Prescriber

The prescriber provides specifies the desired medication therapy and related details of the prescription. This information is captured by the enrollment application and transmitted to a patient support program or other assisting party using the enrollment initiation message described below.

After payment for the medication has been arranged and an authorized pharmacy identified by the patient support program, that information is transmitted back to the prescriber practice so that the prescription can be completed and transmitted to a pharmacy.

Prescriber Agent

The prescriber agent can provide information on behalf of the prescriber. Example: clinic staff.

Patient

The patient provides contact preferences and other enrollment-related information, as well as providing their consent for sharing of clinical information, choices related to patient support programs, and authorization for activites performed on their behalf during the enrollment process.

The information and consents they provide are captured by the enrollment application and transmitted to the patient support program or other assisting party using the enrollment initiation message described below.

Patient Support Program or Other Party Supporting Fulfillment of the Prescription

Staff at a specialty patient support program or other entity helping fulfill the prescription use the enrollment information supplied by the prescriber practice in activities such as benefits investigation, insurance authorization and enrolling the patient in support programs. It provides information including an authorized dispensing pharmacy and updated insurance information back to the prescriber.

System Roles

Each system supporting either the prescriber (the enrollment application) or staff supporting fulfillment of the prescription (e.g., the patient support program system) play both:

  • a Data Source System role (when transmitting information) and
  • a Data Consumer Role (when receiving information).

The terms “Data Source” and “Data Consumer” are used in process and data descriptions used elsewhere in this guide.

Use Cases

The guide supports two basic use cases:

Enrollment Initiation

  • As the enrollment application used by the prescriber, I need to supply patient enrollment information to a patient support program or other party that is supporting fulfillment of the prescription. That includes clinical information from the patient’s medical records, insurance and contact information, details of the prescribed medication therapy, and patient consent information.

    • In this scenario, the enrollment application is the Data Source, and the system used by patient support program staff is the Data Consumer
    • This scenario is supported by the Initiation message

Enrollment Update

  • As a patient support program or other party supporting fulfillment of the prescription, I need to return information and updates associated with my activities, including insurance authorization details, approved dispensing pharmacy and authorized prescription details.

    • In this scenario, the system used by patient support program staff is the Data Source, and the enrollment application is the Data Consumer
    • This scenario is supported by the Update message

Exchange Flows

The picture below illustrates the where the Iniation Message and Update Message fit in the overall enrollment process.