White Papers

Electronic Billing of Million Dollar Claims Using Telecommunication Standard D.0 White Paper


While NCPDP stands by the recommendation to bill million dollar pharmacy claims using the Universal Claim Form to remain HIPAA compliant, this document explores the two different electronic submission methods for million dollar or higher pharmacy claims and the various industry impacts potentially encountered by pharmacies, payers/processors and other entities.

NCPDP Electronic Signature Guidance


NCPDP announces the release of version 1.1 of this document that provides clarification and guidance to the industry for the use of electronic signatures associated with electronic prescriptions, including validation, authentication, and meeting regulatory requirements. This white paper is intended to assist prescribers, pharmacy and third party auditors in validating the available data transmitted and stored using industry approved datasets.

Identification of Pharmacy Provider Clinical Documentation for Medicare Part D Medication Therapy Management (MTM) Programs Beneficiary-Level Data Reporting White Paper


MTM Beneficiary-Level Data Reporting White Paper

Collecting and Exchanging Social Determinants of Health Data in the Pharmacy White Paper


Social Determinants of Health White Paper

Facilitating Access to Specialty Products An NCPDP Review and Recommendations White Paper


This paper offers recommendations to manufacturers, prescribers, payers and pharmacies regarding the information related to hub services and limited distribution products.

Standardized Medication Profile


The HL7/NCPDP Standardized Medication Profile white paper.

NCPDP GS1 DataMatrix White Paper


This White Paper discusses the issues associated with removal of the GS1 UPC-A and provides recommendations in supporting the requirements for manufacturers to affix or imprint the new product identifier to each package and homogenous case of a product.

Controlled Substance - Quantity Prescribed White Paper


The purpose of this white paper is to provide information and guidance on the use of the Quantity Prescribed (460-ET) field to address the Schedule II controlled substances (CII’s) billing issues identified in the September 2012 OIG report and to address issues with state requirements related to CII’s for dispensing of medication in increments less than the amount prescribed.

Qualified Medicare Beneficiary Part B Coordination of Benefit Barriers and Recommendations


The purpose of this document is to provide electronic data solutions to current barriers for processing claims secondary to a Medicare Part B benefit for Qualified Medicare Beneficiary (QMB) Program participants that align with QMB Program requirements.

NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications


This paper provides the healthcare industry, in particular the pharmacy sector, with historical and background information on the patient risks associated with the dosing of liquid medications and recommendations to mitigate those risks through best practices in prescription orders, prescription labeling and the provision of dosing devices.

NCPDP Specialty Pharmacy Benefit Coverage Identification White Paper 


The purpose of this white paper is to highlight current challenges experienced by providers, specialty pharmacies and organizations in being able to timely and accurately identify the appropriate benefit coverage (medical or pharmacy benefit) for a specific medication being prescribed, as well as potential out-of-pocket costs to the patient at the time of care. Overall, the desired outcome of benefit identification is to provide a comprehensive benefit coverage overview electronically at the time the medication is selected and to improve a patient’s ability to begin therapy without delay. This process should be easily accessible without multiple manual steps or duplication of efforts by providers, specialty pharmacies and hubs.

NCPDP Standards-based Facilitated Model for PDMP: Phase I and II


The white paper has been updated to add Phase II which supports real-time reporting and risk response in addition to Phase I functionality. The facilitated model leverages current industry technology and clinical expertise to create and/or communicate potential risks using an algorithm (e.g., risk score). The facilitated model also supports prescribers and dispensers with information to assist in making an appropriate clinical decision.

Medicaid Drug Rebate Program-Challenges Across the Industry


This white paper intends to educate interested parties regarding the general operational aspects of the Medicaid Drug Rebate Program (MDRP), provide a high-level description of the various end-to-end processes involved in the administration of the MDRP, identify challenges related to Medicaid drug rebate invoicing, billing quantity discrepancies, and the reconciliation between state Medicaid agencies and participating pharmaceutical manufacturers, offer recommendations for modifying processes with a focus on improved efficiencies for all parties involved in the administration of Medicaid rebate transactions and communicate key recommendations to the Centers for Medicare & Medicaid Services (CMS) MDRP Operations group with a goal of streamlining the process for all stakeholders.

Billing Guidance for Pharmacists' Professional and Patient Care Services White Paper


This paper provides the pharmacy sector of the healthcare industry with guidance on the billing of pharmacists' clinical services.

Dates Associated with Pharmaceutical Products


This white paper provides the pharmaceutical industry with a guide to understanding dates associated with FDA-approved pharmaceutical products entering and leaving the market and how different stakeholders in the drug delivery industry utilize these dates.

The Proper Use of the NCPDP™ Telecommunication Standard Version D.0 as it applies to the Implementation of Medicaid Reimbursement Methodologies Based on Actual Acquisition Cost (AAC) Plus a Professional  Dispensing Fee


This white paper provides Medicaid agencies and fiscal agents guidance in implementing new acquisition cost based reimbursement rules for covered outpatient drugs. The paper presents common issues experienced to-date in implementing cost based reimbursement with professional dispensing fees. It highlights how to best utilize the NCPDP Telecommunication Standard Version D.0 and leverages best practices for various scenarios such as preferred brands for multisource generic situations and the proper use of the Dispense As Written (DAW)/Product Selection Code (408-D8) field values to inform pharmacies of formulary requirements.

Recommendations for Use of the NCPDP Telecommunication Standard to Prevent Use of Copayment Coupons by Medicare Part D Beneficiaries and Applicability to other Federal Programs


This paper provides recommendations for the best available long term solution to prevent the use of copayment coupons for drugs paid for by Medicare Part D.

NCPDP Medicare Part D Plans Moving Processors White Paper


This white paper outlines the scenarios relevant to Medicare Part D Plans

NCPDP Recommendations for Dose Accumulation Monitoring in the Inpatient Setting: Acetaminophen Case Model


This paper provides the healthcare industry, in particular the pharmacy and inpatient facility sectors, with historical and background information on the patient risks associated with hidden sources of acetaminophen and recommendations for best practices to mitigate those risks through facility management and electronic medical record systems.

Universal Medication Schedule (UMS)


This white paper introduces the concept of the Universal Medication Schedule (UMS) and lays out a set of best practices for implementing it using NCPDP’s SCRIPT Standard. UMS simplifies medication administration instructions for the patient and/or caregiver, promoting increased medication adherence and improved patient safety. The SCRIPT Standard supports transmission of the UMS through the use of the Sig segment when an electronic prescription is transmitted from a prescriber to a pharmacy.

NCPDP Recommendations for Improving Prescription Drug Monitoring Programs


NCPDP has shared its Recommendations for Improving Prescription Drug Monitoring Programs with the Office of the National Coordinator for Health Information Technology (ONC) for inclusion in the ONC’s Standards and Interoperability Framework. NCPDP has also been educating policymakers about the need for timeliness and interoperability in a PDMP solution. The NCPDP white paper recommendations were developed by a PDMP Task Group formed as an outcome of a multi-stakeholder NCPDP focus group held in October 2012. The focus group was convened to identify the specific challenges and goals of PDMPs across all stakeholder groups and create an action plan to achieve standardization. The task group set out to propose efficient solutions that leverage existing standards and workflows to facilitate standardization and adoption at a national level.

NCPDP Recommendations for Improved Prescription Container Labels for Medicines Containing Acetaminophen Version 1.1 and Version 1.0


Building on findings and recommendations of Version 1.0, Version 1.1 of this white paper details the compelling progress made in response to NCPDP’s recommendations and call to action for industry stakeholders to address the public health issue of accidental acetaminophen overdose. The Executive Summary provides a snapshot of actions taken and guidance for continued implementation since Version 1.0 of the white paper was first published in 2011. Developed by NCPDP Work Group 10: Professional Pharmacy Services.

NCPDP Implementation Timelines and Recommendations for ICD-10


Guidance to the pharmacy industry in preparing for the implementation of the ICD-10-CM and ICD-10-PCS code sets. Developed by the NCPDP Strategic National Implementation Process (SNIP) Committee.