Public Documents
This section of our website is intended to share various NCPDP documents which are of interest to the pharmacy services sector of the health care industry. Subsections include information on:
Tamper-Resistant Prescription PadsLong Term Care Rebate Reporting Guidance
Pharmacy Identification Card
Rebate Reference Guide
X12N 835 Payment Template
Version 5 Editorial
HIPAA Transactions and Code Sets
NCPDP Strategic National Implementation Process
Information about NCPDP Task Groups
Tamper-Resistant Prescription Pads
On January 16, 2008, the National Council for Prescription Drug Programs (NCPDP) held an industry forum in an effort to bring conformity to State-issued guidelines regarding Federal legislation on Tamper-Resistant Prescription Pads. The CMS guidelines are broad enough to allow states considerable flexibility but it leaves states with the challenge of deciding how exactly they wish to meet the Federal guidelines. Conformity among states is important to insure broad compliance and to facilitate the processing of prescriptions across State lines. The attached letter recommends features that should be included in state regulations. The adoption of these features will lead to uniformity of the state regulations which will reduce cost and make cross border enforcement less cumbersome.
Also attached is a model letter for prescribers in your state that you may use as is or as a template. This, along with the suggested features that you choose, will help expedite compliance by all parties by the April 1, 2008 deadline.
Long Term Care Rebate Reporting Guidance
WG14 Long Term Care Pharmacy Rebate Task Group, in collaboration with Centers for Medicare and Medicaid (CMS), developed the "Long-Term Care (LTC) Rebate Reporting Guide for Medicare Part D". This document provides guidance for LTC pharmacies in reporting rebates to Part D sponsors or Pharmacy Benefit Managers representing Part D sponsors, and identifies inherent limitations in both the scope and the use of the data.
In February, the "Long-Term Care (LTC) Rebate Reporting Guide for Medicare Part D" was modified to reflect the 2008 CMS requirement for reporting drugs at the NDC level. Click here to view the updated document.
In addition, Members of WG14 participated in development of an industry-wide consolidator for pharmacy reported rebates. If you are a PBM or Part D Plan and would like to explore using this solution, as opposed to building/maintaining your own, please contact Linda Campbell at lcampbell@smithpremier.com or visit the Smith Premier Rebate Reporting web page at www.premierltcsubmit.com.
Pharmacy Identification Card
NCPDP Pharmacy ID Card Fact Sheet
The following document relates to the current NCPDP Health Care
Identification Card Pharmacy ID Card Implementation Guide. The purpose
of the fact sheet is to provide details about the NCPDP format and may be
distributed to members and non-members. If you have any questions about the
fact sheet, please contact
Kittye Krempin at the Council office at
(480)477-1000 ext. 134.
NCPDP Pharmacy ID Card Fact Sheet
Qualifier Code Values for Use in Discretionary Data Loop
This document is Appendix H—Health Care ID Card Values of the NCPDP External Code List. Health Care ID Card Qualifier Codes enable card issuers to include information such as effective dates of benefit coverage, cardholder address, dependent names and person codes, gender codes, dates of birth, etc. and support full implementation of machine-readable information on Healthcare ID Cards. Click here for a copy of this document.
Mapping of the Pharmacy ID Card to the ASC X12N 270/271
This document maps the Pharmacy ID Card data fields to the fields in the ASC X12N 270/271 transaction to give the industry guidance on where the fields should be populated should an NCPDP standard-based pharmacy ID card be presented to a prescriber who uses the X12N 270/271 standard to verify eligibility.
Rebate Reference Guide
WG7 Manufacturer Rebates has created a manufacturer rebates reference guide document. This document provides guidance on a variety of manufacturer rebate scenarios and issues found in the Pharmaceutical industry and will assist in the effective implementation of the NCPDP Manufacturer Rebate Utilization, Plan, Formulary, and Reconciliation Flat File Standard V 3.0 or greater on which the contents of this document are based. Click here for a copy of this document.Top
X12N 835 Payment Template
WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the ASC X12N 835 (004010X091A1) Pharmacy Remittance Advice Template was completed November 2007. The ASC X12N 835 (004010X091A1) Pharmacy Remittance Advice Template must be used in conjunction with the ASC X12N 835 V4010/4010A1 Implementation Guide and does not supercede the HIPAA Implementation Guide. The template is meant to supplement the provider manuals that payers build. Payers can use this template to convey the important features of supporting the ASC X12N 835 Implementation Guide to their business partners
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Version 5 Editorial
Frequently Asked Questions, Important Editorial Changes
This document provides a consolidated reference point for questions that have been posed based on the review and implementation of the NCPDP Telecommunication Standard, Implementation Guide, and Data Dictionary for Version 5. This document also addresses editorial changes made to these documents. Since the HIPAA-named Standards documents are "frozen" from changes, this document provides helpful FAQs, typographical changes and corrections, and further guidelines for implementation. This document is very important to implementers of the Telecommunication and Batch Standards. Please continue to review this link as the document is updated as needed. Click here
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