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:

Prescription Monitoring Programs

Prescription Drug Monitoring Programs are a major tool being used by states to address prescription drug abuse, addiction and diversion. Such programs are commonly referred to as PMPs. A PMP is a statewide electronic database which collects designated data on controlled substances dispensed in the state. The PMP is housed by a specified statewide regulatory, administrative or law enforcement agency. The housing agency distributes data from the database to individuals who are authorized under state law to receive the information for purposes of their profession.

WG9 Government Programs has created a document which provides information for State PMPs. Information includes program name, schedules monitored, format, batch/on-line, submission methods, reporting frequency, processor, overseeing agency and contact information. Click here for a copy of this document.

The Office of the National Coordinator (ONC) has created a public resource for PDMP.

Top

Tamper-Resistant Prescription Pads

On June 26, 2008, the National Council for Prescription Drug Programs (NCPDP) held a second industry forum in an effort to review the implementation of the first phase of the CMS tamper-resistant regulations and to discuss next steps necessary to ensure a smooth transition into the second phase of implementation on October 1. As a result of this meeting, industry standards for copy, erasure/modification, and counterfeit resistance have been clarified. Also, CMS had previously stated that prescriptions printed from EMRs or ePrescribing applications would likely need special copy resistant paper to be in compliance as of October 1, 2008. CMS is now clarifying that guidance, based on its awareness of improved printing capabilities, and is now stating that while special paper may be used to achieve copy resistance, it is not a requirement. EMR or ePrescribing generated prescriptions may be printed on plain paper and be fully compliant with all three categories of the tamper-resistant regulations provided they contain at least one feature from each of the three categories.

The attached letter recommends best practices developed by the industry forum and is strongly suggested for adoption in order to meet the tamper-resistant requirements.

In addition to this guidance, we have created a template letter for you to use when communicating this information to your prescriber community. You are encouraged to modify this letter with your state specific requirements.

Top

Drug Pedigree, Messaging and Tracking: Glossary of Terms

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 and Healthcare Identification Cards

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 Reference Guide documents for the Manufacturer Rebate Standard versions v03.02 and v04.01. These documents provide guidance on a variety of manufacturer rebate scenarios and issues found in the Pharmaceutical industry and will assist in the effective implementation of these versions of the NCPDP Manufacturer Rebate Utilization, Plan, Formulary, and Reconciliation Flat File Standard. Click here for a copy of this document.

Top

ASC X12N 835 Payment Guidance and Related Documents

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the NCPDP Pharmacy Reference Guide to the ASC X12/ØØ5Ø1ØX221 Health Care Claim Payment/Advice (835) was completed May 2010 and updated in August 2Ø12. The NCPDP Pharmacy Reference Guide to the ASC X12/ØØ5Ø1ØX221 Health Care Claim Payment/Advice (835) document must be used in conjunction with the X12/ØØ5Ø1ØX221 and does not supercede it. The reference document is meant to supplement the provider manuals that payers build. Payers can use this document to convey the important features of supporting the X12/ØØ5Ø1ØX221 to their business partners.

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has prepared a White Paper as guidance to the pharmacy industry to prepare for the implementation of the ASC X12/ØØ5Ø1ØX221 Health Care Claim Payment/Advice (835).

WG45 External Standards Assessment, Harmonization and Implementation Guidance Work Group has prepared a mapping document for consistent use of the Claim Adjustment Reason Codes (CARC), Claim Adjustment Group Codes (CAGC) and NCPDP Reject Codes in the ASC X12 835.

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Payer Audit Reporting Transaction was completed August 2Ø12. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated post payment audit and adjustment of pharmacy claims using the ASC X12/ØØ5Ø1ØX221 Health Care Claim Payment/Advice (835).

WG45 External Standards Assessment, Harmonization and Implementation Guidance revision of the Low Income Subsidy (LIS) Reporting Transaction was completed August 2Ø12. This document provides guidance to the pharmacy sector of the health care industry for reporting the outcome of a payer initiated retro-active Low Income Subsidy (LIS) adjustment of pharmacy claims using the ASC X12/ØØ5Ø1ØX221 Health Care Claim Payment/Advice (835) to their long term care (LTC) business partners.

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. Version 5 Editorial - November 2010

Top

Version D 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 D. 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, and Medicaid Subrogation Implementation Guide, as appropriate . Please continue to review this link as the document is updated as needed. Version D Editorial - April 2013

Top

State of the States Public Document

Risk Evaluation and Mitigation Strategy (REMS)

• WG1 Telecommunication - REMS Task Group
  • This task group is assessing the FDA Amendments Act of 2007 to determine if there is an opportunity for NCPDP to define data communication standards for any of the identified professional activities or processes, guide to influence the Food & Drug Administration and their REMS recommendations and their impact on the pharmacy, physician, and pharmaceutical manufacturing segments of healthcare, develop data communication and process standards supporting the REMS guidelines of the FDA Amendments Act of 2007.This task group will complete the development of a point-to-point transaction.
• WG2 Product Identification – Structured Product Labeling (SPL) REMS Requirements Task Group
  • This task group is gathering the data needed to develop a template for pharmaceutical manufacturers to use in submitting electronically all the components for risk evaluation and mitigation strategies (REMS) drugs to a central repository (DailyMed) via FDA’s Structured Product Labeling system.
• WG11 ePrescribing and Related Transactions - REMS and ePrescribing Task Group
  • o This task group is evaluating the activities between pharmacy and prescriber, prescriber and manufacturer for safe use programs.

340B Reference Guide

The NCPDP 34ØB Information Exchange Reference Guide was developed to meet the industry needs for electronic communication between trading partners of an individual prescription or prescription claim’s status under the 34ØB drug pricing program.
Click here for a copy of this document.

Central Pay - Payment Reporting using X12N 835 – 004010X091A1

WG45 External Standards Assessment, Harmonization and Implementation Guidance of the Central Pay Reporting was completed November 2010. This document provides guidance to the pharmacy sector of the health care industry for the reporting of consolidated payments for pharmacies of which their payments are sent to a central entity. This document provides various options for this central pay business and how to utilize the ASC X12N 835 004010X091A1 Health Care Claim Payment/Advice in reporting the consolidated check and reporting individual pharmacy’s activity.

Medicare Part D Frequently Asked Questions

This document provides a consolidated reference point for questions that have been posed and warrant consistent application across the industry of Medicare Part D policy where claims or other applicable transactions, Prescription Drug Events (PDE) are involved. Please continue to review this link as the document is updated as needed.