Public Review of Proposed NCPDP Standards Information

Public comments are solicited on proposed new standards and proposals to revise, reaffirm or withdraw approval of existing standards simultaneously with the NCPDP ballot period. The NCPDP Public Review of Proposed NCPDP Standards period opens on Friday, September 13, 2019 and closes Monday, October 28, 2019. Should you wish to submit an Official Public Comment, the Council must receive your Official Public Comment no later than 5:00 p.m. PDT/ 6:00 p.m. MDT/ 7:00 p.m. CDT/ 8:00 p.m. EDT on Monday, October 28, 2019. All explanatory comments submitted on "Object with Reason" and "Accept with Comments" will be reviewed at the next scheduled Joint Technical Work Group meeting, which will be held November 6 - 8, 2019 in St. Petersburg, FL. The proposed NCPDP standards packets are:

  1. Proposed NCPDP Standards Packet #WG010084

    Proposed NCPDP Standards Packet #WG010084
    WG01 Telecommunication - Proposed NCPDP Standards Packet #WG010084 for enhancements to the Telecommunication Standard Implementation Guide, Post Adjudication Standard Implementation Guide, Audit Standard Implementation Guide, Prescription Transfer Standard Implementation Guide, Prior Authorization Transfer Standard Implementation Guide and Uniform Healthcare Payer Data Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1683 which requested a new response segment, Response Provider, and two new data elements, Invalid Provider Data Source and Invalid Provider Data Source State Code to communicate additional information to pharmacies, and, in turn, prescribers, regarding the Point of Service provider-related rejection.
    • DERF 1686 which requested to update Section 28.3.3 Other Payer Amount Paid (431-DV) of the Telecommunication Standard Implementation Guide and inclusion in the Telecommunication Standard Version F2 and above Editorial and Best Practices document.
    • DERF 1688 which requested to sunset field CMS Part D Defined Qualified Facility (997-G2) in the Telecommunication Standard as the Patient Residence (384-4X) field has enough detail to support any previously intended uses of this field.
    • DERF 1691 which requested the definition and name of Formulary Alternative Cost Share Incentive (555-AT) be modified to better align with the industry usage of the field. Field name changed to Formulary Alternative Estimated Patient Cost Share.
    • DERF 1694 which requested modifications to the DUR/PPS Response segment to capture within codified fields critical detail regarding the DUR conflict that is currently being returned in 30- and 100-byte text fields to increase patient safety, workflow efficiencies and better support harmonization of the DUR information communicated between the payer, pharmacy, prescriber and patient.
      • Add 16 new fields to the Telecommunication Standard
      • Modify field name of 476-H6 DUR Co-Agent ID and 475-J9 DUR Co-Agent ID Qualifier
      • Expand usage of 476-H6 DUR Co-Agent ID and 475-J9 DUR Co-Agent ID Qualifier to include in the RESPONSE transaction (currently only in request)
      • Modify field name and length of 544-FY DUR Free Text Message
      • Sunset 570-NS DUR Additional Text
    • DERF 1695 which requested the creation of a new field, "Formulary Alternative Effective Date", as part of the "Response Claim Segment" in the Telecommunication Standard to aid in the proactive communication of upcoming formulary change information with both patients and prescribers, mitigating access to care and adherence risks.
    • DERF 1716 which requested to increase field length of Original Manufacturer Product ID (C01-4N) to align with the field length of other product identification fields.
    • DERF 1717 which requested the incorporation of the Other Payer Percentage Tax Exempt Indicator (D51-P7) and the Other Payer Regulatory Fee Type Count (D53-P9), Other Payer Regulatory Fee Type Code (D63-RN), and Other Payer Regulatory Fee Exempt Indicator (D52-P8) grouping into the "COORDINATION OF BENEFITS/OTHER PAYMENTS SEGMENT," "In Payment Scenarios" details (these fields should not need to be grouped with the "In Reject Scenarios" section) of the Telecommunication Standard. The indication that the Other Payer Coverage Type (338-5C) field, "May be grouped with the Other Payer Percentage Tax Exempt Indicator (D51-P7), the Other Payer Regulatory Fee Type Count (D53-P9) and its grouping, and/or the Benefit Stage Indicator Count (C50-9W) and its grouping, when applicable for the Other Payer.” Should be added within the Coordination of Benefits/Other Payments Segment section.
    • DERF 1724 which requested to increase the field length for 411-DB Prescriber ID, 421-DL Primary Care Provider ID, 580-XY Associated Prescription/Service Provider ID, A26-ZP Prescriber Alternate ID and 444-E9 Provider ID from 15 to 35 to support state license number formats that expand beyond 15 characters and to promote harmonization of field lengths across the NCPDP Standards/Forms using these data elements.
    • DERF 1725 which requested to remove the Section Header and all verbiage in Section 27.2.3 Response Insurance Segment from all future versions of the Telecommunication Implementation Guide since this language is currently found in Telecommunication Implementation Guide Version F4 and earlier versions as far back as v5.0.
    • DERF 1728 which requested updating the Response Other Related Benefit Detail Segment to be used in Claim Billing, Predetermination of Benefits, Service Billing, Prior Authorization Inquiry and Prior Authorization and Billing responses.
    • Approval of proposed packet #WG010084 would result in the release of the Telecommunication Standard Implementation Guide Version F6, Post Adjudication Standard Implementation Guide Version 51 , Audit Standard Implementation Guide Version 35, Prescription Transfer Standard Implementation Guide Version 38, Prior Authorization Transfer Standard Implementation Guide Version 25 and Uniform Healthcare Payer Data Standard Implementation Guide Version 28

  2. Proposed NCPDP Standards Packet #WG010085

    Proposed NCPDP Standards Packet #WG010085
    WG01 Telecommunication - Proposed NCPDP Standards Packet #WG010085 for enhancements to the Benefit Integration Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERF:

    • DERF 1709 which requested to update and expand the use of drug identifiers within the SCRIPT, Specialized and Benefit Integration Standards.
    Approval of proposed packet #WG010085 would result in the release of the Benefit Integration Standard Implementation Guide Version 16

  3. Proposed NCPDP Standards Packet #WG020010

    Proposed NCPDP Standards Packet #WG020010
    WG02 Product Identification - Proposed NCPDP Standards Packet #WG020010 for enhancements to the Product Identifiers Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERF:

    • DERF 1726 which requested editorial modifications to the Product Identifiers Standard Implementation Guide to remove references to Appendix B of the External Code List (ECL) and Appendix D of the Telecommunication Standard Implementation Guide. Approval of proposed packet #WG020010 would result in the release of the Product Identifiers Standard Implementation Guide Version 1.5

  4. Proposed NCPDP Standards Packet #WG090013

    Proposed NCPDP Standards Packet #WG090013
    WG09 Government Programs - Proposed NCPDP Standards Packet #WG090013 for the initial release of the State Medicaid Provider File Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERF:

    • DERF 1702 which requested approval of a new standard, the State Medicaid Provider File Standard to streamline the communication of provider enrollment data from State Medicaid agencies to the applicable stakeholders.
    Approval of proposed packet #WG090013 would result in the initial release of the State Medicaid Provider File Standard Implementation Guide Version 10

  5. Proposed NCPDP Standards Packet #WG090014

    Proposed NCPDP Standards Packet #WG090014
    WG09 Government Programs - Proposed NCPDP Standards Packet #WG090014 for enhancements to the Prescription Drug Monitoring Programs (PDMP) Reporting Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERF:

    • DERF 1724 which requested to increase the field length for 411-DB Prescriber ID, 421-DL Primary Care Provider ID, 580-XY Associated Prescription/Service Provider ID, A26-ZP Prescriber Alternate ID and 444-E9 Provider ID from 15 to 35 to support state license number formats that expand beyond 15 characters and to promote harmonization of field lengths across the NCPDP Standards/Forms using these data elements.
    Approval of proposed packet #WG090014 would result in the release of the Prescription Drug Monitoring Programs (PDMP) Reporting Standard Implementation Guide Version 12

  6. Proposed NCPDP Standards Packet #WG100010

    Proposed NCPDP Standards Packet #WG100010
    WG10 Professional Pharmacy Services - Proposed NCPDP Standards Packet #WG100010 for the initial release of the HL7 CDA® R2 Implementation Guide: Pharmacist Care Plan Document
    This proposed packet contains the following requests from the listed DERF:

    • DERF 1729 which requested to collaborate with HL7 to adopt an electronic care plan with enhanced medication management content based on the templates in the HL7 Implementation Guide for C-CDA Release 2.1: Consolidated CDA for Clinical Notes and C-CDA on FHIR R4. This care plan called “Pharmacist Care Plan” will serve as a standardized, interoperable document for exchange of consensus-driven prioritized medication-related activities, plans and goals for an individual needing care. Pharmacists work in multiple environments (community, hospital, long term care, clinics, etc.) and increasingly participate in patient-centered care teams providing essential clinically oriented patient care services such as medication therapy management, clinical reconciliation (medication, allergies and problems), patient immunization management, disease state monitoring, and therapy adherence programs.
    Approval of proposed packet #WG100010 would result in Release 1 of the HL7 CDA® R2 Implementation Guide: Pharmacist Care Plan Document

  7. Proposed NCPDP Standards Packet #WG110082

    Proposed NCPDP Standards Packet #WG110082
    WG11 ePrescribing & Related Transactions - Proposed NCPDP Standards Packet #WG110082 for enhancements to the Formulary and Benefit Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1675 which requested to reuse the message link in the detail file (C26-6Y Message Link) to rectify the issue where any file with a C20-6S General Message Link (located in the header) does not link to a message file.
    • DERF 1676 which requested implementation guide changes to add conditional logic support to the Prior Authorization file; allowing the payer and EHR to display/hide coverage restrictions based on the patient’s age or gender.
    • DERF 1678 which requested implementation guide changes to make coverage restrictions required when coverage file fields are sent.
    • DERF 1679 which requested implementation guide changes to support a single Alternative Product Groups file and a single Step Therapy Products Group file and allow each file type to have only one file per Sender ID.
    • DERF 1680 which requested implementation guide modifications and a new field to support indication-based formularies.
    • DERF 1681 which requested to add a value to Formulary Status (927-FP) and to modify the Formulary and Benefit Standard Implementation Guide to allow payers to properly identify carve out drugs.
    • DERF 1682 which requested the addition of two fields, Quantity Unit of Measure Code and Quantity Unit of Measure Code Qualifier, to clarify the intention of quantity limits and to allow the EHR to proactively trigger Prior Authorization if a prescriber chooses to prescribe a quantity that falls outside of the allowed limit.
    • DERF 1735 which requested the addition of a new field, Look Back Period, in the Benefit Coverage Files/Step Therapy and Step Products file to indicate how far back a Step Medication trigger should "look" to see if the step drug has been tried before selecting the trigger drug.
    Approval of proposed packet #WG110082 would result in the release of the Formulary and Benefit Standard Implementation Guide Version 53

  8. Proposed NCPDP Standards Packet #WG110083

    Proposed NCPDP Standards Packet #WG110083
    WG11 ePrescribing & Related Transactions - Proposed NCPDP Standards Packet #WG1100813 for enhancements to the SCRIPT Standard Implementation Guide and Specialized Implementation Guide
    This proposed packet contains the following requests from the listed DERFs:

    • DERF 1707 which requested to modify the electronic prior authorization sections of the SCRIPT Standard Implementation Guide to provide clarity, consistency, and readability.
    • DERF 1709 which requested to update and expand the use of drug identifiers within the SCRIPT, Specialized and Benefit Integration Standards.
    • DERF 1710 which requested to modify the Census guidance in the Specialized Implementation Guide to provide clarity of use.
    • DERF 1733 which requested to simplify the reasons for updating NewRx’s in the LTPAC workflow outlined in the SCRIPT Implementation Guide by updating the guidance and note and removing specific code callouts in the language within section 5.14 and to sunset one code and update the definitions of two codes in MessageRequestCode.
    Approval of proposed packet #WG110083 would result in the release of the SCRIPT Standard Implementation Guide and Specialized Implementation Guide, both to be known as Version 2020xx# (Version number to be assigned once Board approval is obtained)

  9. Proposed NCPDP Standards Packet #WG180003

    Proposed NCPDP Standards Packet #WG180003
    WG18 Specialty Pharmacy - Proposed NCPDP Standards Packet #WG180003 for enhancements to the Specialty Pharmacy Data Reporting Standard Implementation Guide
    This proposed packet contains the following requests from the listed DERF:

    • DERF 1724 which requested to increase the field length for 411-DB Prescriber ID, 421-DL Primary Care Provider ID, 580-XY Associated Prescription/Service Provider ID, A26-ZP Prescriber Alternate ID and 444-E9 Provider ID from 15 to 35 to support state license number formats that expand beyond 15 characters and to promote harmonization of field lengths across the NCPDP Standards/Forms using these data elements.
    Approval of proposed packet #WG180003 would result in the release of the Specialty Pharmacy Data Reporting Standard Implementation Guide Version 13

  10. Proposed NCPDP Standards Packet #WGMC0007

    Proposed NCPDP Standards Packet #WGMC0007
    WGMC Maintenance and Control - Proposed NCPDP Standards Packet #WGMC0007 for the initial release of the Real-Time Prescription Benefit Standard Implementation Guide and enhancements to the XML Standard This proposed packet contains the following requests from the listed DERF:

    • DERF 1712 which requested the creation of a Real-Time Prescription Benefit Standard to meet the two industry needs within the pharmacy services sector: to facilitate the ability for pharmacy benefit payers/processors to communicate formulary and benefit information to providers and to ensure a consistent implementation of the standard throughout the industry. The Standard enables the exchange of patient eligibility, product coverage, and benefit financials for a chosen product and pharmacy, and identifies coverage restrictions, and alternatives when they exist. The Standard will support two formats, EDI and XML, but will have a single implementation guide and common data content.
    Approval of proposed packet #WGMC0007 would result in the release of the Real-Time Prescription Benefit Standard Implementation Guide Version BT (Beta Test intended for pilot use) and the XML Standard Version 2020xx# (Version number to be assigned once Board approval is obtained)

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