NCPDP's SCRIPT 10.6 enhances e-prescribing

SCRIPT Version 10.6, the standard for e-prescribing and related transactions that the National Council for Prescription Drug Programs (NCPDP) has been recommending for several years, will be coming into use in upcoming months, according to NCPDP.

Ken Whittemore, RPh, senior vice president, regulatory affairs, SureScripts, confirmed that his group will begin certifying vendors shortly. Adoption of the system is expected to begin incrementally in the last half of this year, with wider adoption expected next year, he said.

Endorsed by the Department of Health and Human Services last year, the standard offers a number of enhancements, according to people working on it. The new version offers benefits that people in the field have anticipated for some time, Whittemore asserted.

At present, most e-prescribing transactions that are performed electronically are using SCRIPT 8.1, said Lynne Gilbertson, vice president, standards development, NCPDP.

One of the key enhancements that SCRIPT 10.6 will make available is the drug codification system known as RX Norm, which will “provide a more accurate and exact drug selection list, enabling the pharmacist to select the correct drug to dispense,” according to a recent NCPDP webinar that outlined the new system.

Steve Franko, senior portfolio manager for CVS Caremark, stated during the presentation, “I looked at actual data, and for 10 different glipizide 10 mg tablets in the existing world today, [there were] 82 different ways it was specified in the drug name field.”

SCRIPT 10.6 also includes an enhanced “Sig” codification, NCPDP noted. As explained during the webinar, the Sig contains the instruction on how the patients should take the medication and “it must be legible, unambiguous, and complete, to ensure that the prescriber’s instructions for use of the product are understood.”

According to Laura Topor, director, account management, RxEOB, “What we have built truly will accommodate 98% or 99% of the Sigs that are written.”

Whittemore of Surescripts told Drug Topics that it will be interesting to see how quickly the Sig function is adopted, because it is complicated. However, he said, it has long been called for.

SCRIPT 10.6 also supports a medication-history source feature that can show where the history was obtained and the identity of the source. It includes the capacity to consolidate histories from different sources, the NCPDP materials say.

The system also provides fields for dates of several transactions, with the time of day noted to the second, including:

• Sold date, which is when the patient took possession of the medication
• “Delivered-on” date, the date the facility received it
• Date validated, the date it was reviewed at the facility
• Effective date, which is “to be used in CII Rx’s as a do-not-fill-before date.”

SCRIPT 10.6 also includes a capability for the prescriber to send additional prior-authorization codes, “enabling such a code to be available in the event that the prescription is rejected,” according to NCPDP.

It supports a “scheduled medication” function for use with controlled substances, as well.

NCPDP information also notes that the new system allows for the download of a National Cancer Institute Terminology (NCIt) set that will provide values in 4 fields: DEA schedule, potency unit code, (also called Unit Measure), dosage form code, and strength form code.

In a feature planned for use in e-prescribing of controlled substances, the system supports a “scheduled medication” feature.

A significant issue connected with SCRIPT 10.6, according to Gilbertson, has been the process of getting approval from the federal Centers for Medicare and Medicaid Services.

A July 2010 CMS regulation endorsed SCRIPT 10.6. But that rule allows that both 8.1 and 10.6 may be used for the time being. The NCPDP recommended that the use of 8.1 be phased out by the end of 2012. But it is uncertain when CMS will issue that regulation.

As for e-prescribing in general, in its national progress report SureScripts stated that the number of prescribers routing prescriptions electronically rose from 156,000 in 2009 to 234,000 in 2010; this, it said, represents about 34% of all office-based prescribers. According the report, 1 out of 4 prescriptions is now electronic, up from 1 in 18 just 2 years earlier.

Gilbertson of NCPDP noted that the coming of “meaningful use” standards for electronic health records from the Department of Health and Human Services may also give e-prescribing a boost in future years.

Kathryn Foxhall is a healthcare journalist based in the Washington, D.C. area.