HISTORY & IMPACT

Innovation is in our DNA

For nearly 40 years, NCPDP has led a transformation in the pharmacy services sector by creating and promoting standards for electronic healthcare transactions. Our collaborative, consensus-building process has produced operational efficiencies that save $30 billion annually in healthcare costs, while increasing the safety and quality of patient care.

NCPDP and the pharmacy industry have developed solutions to problems that continue to challenge the rest of healthcare. These include real-time claims adjudication, eligibility and benefit verification, real-time ordering by the physician, and sharing of medication history. The lessons we have learned can be valuable to other healthcare sectors.

Key Milestones

Our Telecommunication Standard made it possible for your pharmacy and you to know, within seconds, your eligibility, drug coverage, and copays at the pharmacy counter. There’s no waiting for a letter from your health plan showing how much they covered and what remains for you to pay. The pharmacy also knows almost instantly how much it will be paid for a claim. And we have the patient safety benefits of real-time clinical alerts on things like potential allergies and interactions with other drugs.

Our Manufacturing Rebate Standard was created to reduce the time and money that State Medicaid agencies spend chasing payments or addressing questions on an invoice. It also improves cash flows, allowing Medicaid agencies to redirect resources to meet patients’ medication needs.

With creation of the Universal Claim Form, we enabled pharmacists to get reimbursed faster...and go home to their families at the end of a workday instead of filling out hundreds of proprietary health plan claim forms.

The NCPDP HCIdea Prescriber Database contains over 2.5 million prescribers with cross-references to the other identifiers used in the industry (e.g. DEA, NPI, state license numbers, etc.). The NCPDP HCID Number provides a unique, national identifying number that assist in identifying prescriber interactions with pharmacies, federal agencies, healthcare entities and third-party payers.

The Health Standards Collaborative, formerly the Standards Charter Organization (SCO), is a collaboration of Standards Development Organizations (SDO) including HL7, X12, HITSP and other stakeholders.

Our white papers with best practices for labeling of prescriptions containing acetaminophen published in 2011 and 2013 resulted in labeling changes to help us, as consumers, clearly identify when a prescription medicine contains acetaminophen. This is critical so we don’t take over-the-counter acetaminophen in combination with the prescription for an unintentional overdose. Overdose of acetaminophen can lead to liver injury and even death. Labeling improvements also included more obvious warnings about liver damage.

Another white paper, published in 2014, called for using mL as a measurement for dosing and labeling liquid medications, especially for our children who are often prescribed liquid medications. Use of teaspoons as measurement often results in overdosing as people tend to use various size spoons, including tablespoons, for administering liquid medication. The white paper provided specific industry guidance for standardizing mL dosing designations and providing mL dosing devices.

Our white paper guidance went into the inpatient setting with recommendations on dose accumulation monitoring in hospitals. Using acetaminophen as a case model, we identified sources of unintentional accidental overdosage and ways to improve safe use in hospitals. The recommendations spanned improving systems, communication, detection during transitions of care, and provider and patient education.

resQ™ is the industry-wide single source-of-truth for pharmacy data. Developed by all stakeholders in a coordinated, collaborative approach to define requirements, establish standards for quality, resQ™ reduces effort and improve efficiency in pharmacy credentialing data collection.

Driven by industry need and demand, NCPDP established a specialty pharmacy work group in 2018 to ease the administrative challenges of managing specialty medications for patients with chronic or complex medical conditions. Industry stakeholders involved in managing specialty medications have identified a number of processes – from enrollment and benefit verification, to prior authorizations, patient consent, and outcomes reporting – that can benefit from standardization to improve care coordination and streamline administrative functions. The work group gives the segment a home to prioritize and work on workflows and transactions that can benefit from standardization. The ultimate goals are to create new transactions or standards to streamline the complex administration of specialty medications and improve speed to therapy for patients whose health and sometimes, their very lives, depend on these medications.

With creation of the Universal Claim Form, we enabled pharmacists to get reimbursed faster...and go home to their families at the end of a workday instead of filling out hundreds of proprietary health plan claim forms.

NCPDP signs agreement with NABP to maintain pharmacy file creating NCPDP Pharmacy ID, which NCPDP now owns.

NCPDP has developed many tools for pharmacists to support patient care, monitor your health outcomes and the safe use of medications – from transactions to request medication therapy management (MTM) services for patients with complex medication regimens or chronic conditions to documentation transactions that describe the MTM services, and may include recommendations for therapy modifications, referrals to other healthcare professionals, and more. We also provide billing guidance for pharmacists providing these patient care services.

Our SCRIPT Standard made ePrescribing possible, significantly improving medication safety for patients. ePrescribing eliminates errors associated with handwritten prescriptions, and dispensing errors due to similar sounding or similar looking drug names. Sending prescriptions electronically also improves compliance. Enhancements to the Standard have given pharmacists ready access to medication history to prevent adverse drug reactions, identify duplicate therapies and optimize drug therapy. It also speeds access to medications that require prior approvals.

The NCPDP Provider Identification Number was developed many years ago to provide pharmacies with a unique, national identifying number that would assist pharmacies in their interactions with federal agencies and third party providers. These numbers are contained in the NCPDP Pharmacy Provider Database, which contains more than 80,000 pharmacies and non-pharmacy dispensing sites. Many processors, pharmacy benefit managers (PBMs), carriers, manufacturers, health plans, State and Federal government entities, and State Pharmacy Boards utilize the NCPDP dataQ™ Pharmacy File for their internal use or to embed in their own proprietary databases or products. The information contained in the NCPDP dataQ Pharmacy File is self-reported by the pharmacy or their Prescription Service Administration Organization (PSAO).

In 2013 and again in 2015, we published recommendations for improving PDMPs by leveraging our widely adopted Telecommunication and SCRIPT Standards to address the opioid epidemic and save lives. The recommended framework gives providers information in real-time, across state lines and across pharmacies, enabling them to intervene in intentional or unintentional abuse and also ensure that patients who have a legitimate need for pain medications can get them in a timely manner. Through our EDvocacy efforts, we have been educating policymakers and industry leaders on the viability and power of our Standards-based Facilitator Model for PDMP.

Accurate patient identification is vital to patient safety – to guard against medication errors, diagnostic errors, procedures being performed on the wrong person, and a host of other issues. NCPDP set out to address the issue using its Telecommunication Standard and SCRIPT Standard to propagate the Universal Patient Identifier (UPI), powered by Experian Health UIM and NCPDP Standards™, throughout the pharmacy system and ultimately throughout the entire healthcare system. We teamed up with Experian Health to make our UPI available through a batch service at no charge to pharmacies, healthcare providers and any healthcare organization that owns and exchanges patient data.

NCPDP Standards Table Data provides a cost-effective solution for updating values and definitions that support the various Standards. The NCPDP Standards Table Data files are system generated from the same web-enabled NCPDP Data Dictionary and External Code List into machine-parsable raw data that can be imported into existing applications.

At the August 2019 Work Group Meetings, members voted to approve a BETA version of the NCPDP Real-Time Prescription Benefit (RTPB) Standard. The vote to approve the BETA version of the Standard passed without opposition, signaling strong support for the Standard from across the industry, with representation from all industry stakeholder groups, including government agencies and industry associations. The NCPDP Real-Time Prescription Benefit Standard has the potential to transform the patient-provider experience and speed time to therapy by making patients’ out of pocket prescription benefit information available to providers at the point of care. It brings an unprecedented level of transparency and actionable information to healthcare providers at the point of prescribing – a critical juncture that can make all the difference in a patient’s adherence to a treatment regimen and health outcomes.

Join us in making healthcare better, safer and more efficient.

Pharmacy: A Prescription for Improving the Healthcare System

Learn how NCPDP’s consensus process can provide a model for creating the health information technology (HIT) solutions essential to new reform efforts. This white paper provides a historical perspective on how NCPDP has transformed pharmacy services.