NCPDP Updates Standards for Health Care Information Exchange in Pharmacy

During the McKesson IdeaShare 2019 Meeting, John Klimek, RPh, senior vice president of standards and industry information for technology with the National Council for Prescription Drug Programs (NCPDP) likened standardizations in health care to the Great Fire of Baltimore in 1904. Why? Because the fire is a great example of what happens when systems do not have standards, since without standardization for couplings in fire hydrants, hundreds of blocks in Baltimore were burned.

“I look at our standards as the standard coupling throughout the industry,” said Klimek. “If you don’t have standards in place, and you have hundreds of kinds of hydrants. It’s the same thing for NCPDP standards, everyone uses the same standard for its efficiency.”

American National Standard Institute accredited, NCPDP is a non-profit organization whose purpose is to standardize the exchange of health care information in order to improve outcomes, while also decreasing costs. The member-driven organization provides a forum and marketplace for diverse membership focused on health care and pharmacy business solutions.

The development process for NCPDP’s standards begin with either a data element request form from members or non-members, changes in current standards, additions to data field, new project development forms or a stakeholder action meeting. It then feeds into a work group divided into various units including telecommunication, product identification, government programs, and professional pharmacy services. The work group develops new standards, enhancements to standards, white papers with best practice recommendations, and industry education.

“When we’re developing standards, we look to see where it fits in the workflow and make sure it doesn’t cause any problems or issues,” Klimek added.

Recently, there have been new changes made to current standardization within the pharmacy industry. Chiefly among these NCPDP standards were the SCRIPT Standard and the NCPDP Telecommunication Standard.

The NCPDP Script Standard

The NCPDP Script Standard is the standard for the transmitting of prescription information between prescribers, pharmacies, payers, and other entities for new prescriptions, refill requests, cancellation notifications, and more. Its updates include a new regulation movement from NCPDP SCRIPT V10.6 as the industry standard to 2017071. The new standard will be effective on January 1, 2020, with no transition period from current version of V10.6, and will include prescription drug administration message, new prescription requests, new prescription response denials, and more.

Additional changes include the sending of laboratory testing data and values, the inclusion of IV administration information and Medication Therapy Management services for specialty, and directions for use which will now allow 1000 characters and are included in the Sig element of SigText. The standard will also include the manufacturer name and lot number and expiration dates on biosimilar drugs within specialty pharmacy.

NCPDP Telecommunication Standard

The Telecommunication Standard includes the communication between pharmacy and payer on subjects such as eligibility verification, claims, services, information reporting, prior authorization, and predetermination of benefits. Currently, the version vD.0 is used in the industry; however, it is recommended that NCVHS will move to vF2 in 2023.

The enhancements will include the following:

• Improvements to response segments.
• Modifications to “Coordination of Benefits” fields.
• Enhancements to the Eligibility transaction.
• More information on payer-directed formulary.
• New fields in Claim Billing Pricing segments related to tax and regulatory fees
• A new “Intermediary” segment for Risk Evaluation and Mitigation Strategies, a drug safety program through the FDA that requires certain evaluations for drugs with serious safety concerns.

“I think 2023 is feasible for [implementation] according to the membership, since the telecommunication standard is very large and has many moving parts,” Klimek said. “We’ve been speaking with those in the industry so that  [pharmacists] don’t have to wait for another 5 years for another version to be implemented. We wanted to see what process needed to be changed so that it is fluid.”

The organization is currently actively working to implement new changes to ensure that the standards are the most up-to-date.

Reference

• Standardization Updates that Impact Your Operations [news release]. McKesson IdeaShare 2019 Meeting. John Klimek, RPh, June 27, 2019.