MANAGED CARE

Many third parties claim HIPAA readiness, survey shows

Nearly half of the health insurers, health maintenance organizations, and pharmacy benefit managers in a recent survey claimed they are ready for pharmacy's new patient privacy data transmission standard. But there's still some uncertainty about whether they will actually hit the Oct. 16, 2002, deadline.

Of the pharmacy payers polled, 48% said they're already compliant with provisions of the Health Insurance Portability & Accountability Act (HIPAA) of 1996. The act requires that Rx claims be transmitted via the version 5.1 standard created by the National Council for Prescription Drug Programs. The survey was conducted among NCPDP members by HealthTrans, a business solution provider for pharmacy payers based in Greenwood Village, Colo.

Of 400 firms contacted by phone, 98 participated, for a 24% response rate. Another 29% said they are working toward compliance and 2% said they've just begun planning for the transition.

Among the 33% of respondents who outsource Rx claims processing, only 13% said their processor is already compliant; 28% said their partner is in the process of becoming compliant; and 16% aren't sure what's happening. That leaves 43% who said their processor has just begun to plan to become compliant.

"There's a bit of wait-and-see, and people are going to run closer and closer to the deadline before they make sure they're compliant," said Louis Hutchison Jr., HealthTrans COO. "We believe the readiness of the payer community is what will help drive readiness on the pharmacy side. Among independents using vendors, those folks are working and moving along, but the chains that manage their own in-house systems are probably on a different schedule."

Some 97% of respondents said they plan to fully implement NCPDP's version 5.1. But whether the pharmacy payers take full advantage of 5.1's business functionality remains to be seen, according to Jack McClurg, HealthTrans CEO/chief technology officer. "Actually having all the capabilities allowed for in 5.1 [fully] implemented is a ways off yet," he told Drug Topics.

Areas of 5.1 that could pay big dividends for payers and pharmacies include partial refills, compounding, and coordination of benefits for patients with secondary health insurance.

Implementation of two other areas are a bit more subtle for payers, said Hutchison. "The ability to bill for services not tied to a prescription and the ability to handle electronic remittances are good ways for payers to offer something back to pharmacies without having to give up competitive rates," he said.

Carol Ukens

Carol Ukens. Many third parties claim HIPAA readiness, survey shows.

Drug Topics

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