Mandate for updated versions of NCPDP's SCRIPT and Formulary &Benefit Standards and the newly- named NCPDP RTPB Standard supports interoperability, improves efficiencies, and includes transactions for better informed clinical decision-making at the point of care to improve the healthcare experience for patients and providers. Register to learn from the experts – Upcoming virtual events to prepare for implementation of the standards.
SCOTTSDALE, Ariz., June 25, 2024 /PRNewswire-PRWeb/ -- NCPDP announced three of its standards have been named by the Centers for Medicare & Medicaid Services (CMS) in the final rule, "Medicare Program; Medicare Prescription Drug Benefit Program; Health Information Technology Standards and Implementation Specifications." The final rule revises Medicare Prescription Drug Benefit (Part D) and Office of the National Coordinator for Health Information Technology (ONC) regulations to implement changes related to required standards for electronic prescribing and adoption of health information technology (IT) standards for U.S. Department of Health and Human Services (HHS) use. ONC is adopting the following NCPDP ePrescribing Standards: NCPDP SCRIPT Standard Version 2023011; the NCPDP Formulary & Benefit Standard Version 60; and NCPDP Real-Time Prescription Benefit (RTPB) Standard Version 13.
The implementation timelines are as follows:
- NCPDP SCRIPT Standard Version 2023011 is required as of January 1, 2028.
- NCPDP Formulary & Benefit Standard Version 60 is required as of January 1, 2027.
- NCPDP RTPB standard version 13 is required by January 1, 2027.
The NCPDP SCRIPT Standard, required by both CMS and ONC, is in widespread use by the industry as the core standard for ePrescribing, and includes electronic prior authorization (ePA) and medication history transactions. The NCPDP SCRIPT Standard Version 2023011 includes significant enhancements over the previously named version, among them: improved extensibility; the addition of Addition of observation elements to Risk Evaluation and Mitigation Strategies (REMS) transactions; added support for dental procedure codes, patient gender and pronouns, patient conditions; redesigned Product/Drug groupings; modifications to Structured and Codified Sig Structure format; support for a three-way, multi-party transaction among prescriber, facility, and pharmacy, to enable EPCS in long-term care (LTC) settings; pharmacy-initiated transfer of electronic controlled substance prescriptions; specific ePA transactions that will be required; and more.
NCPDP's Formulary & Benefit Standard Version 60 and its RTPB Standard Version 13, when used together, provide unprecedented transparency, giving prescribers a complete view of patient-specific medication options and costs to select the most clinically appropriate medication at the point of care and within their existing workflows.
NCPDP's Formulary & Benefit Standard enables pharmacy benefit payers such as health plans and pharmacy benefit managers (PBMs) to communicate formulary and benefit information to prescribers using technology vendor systems. Version 60 includes updates such as: reduced file sizes; enhancements for alternative and step medication including support for reason for use (diagnosis) and more complex step medication programs; support for electronic prior authorization and specialty drugs in coverage files; updates in copay files to allow a minimum and maximum copay range; enhancements for benefit stage copay/deductibles, pharmacy network support, Medicare Part D support and approximate drug cost.
The newly-named NCPDP RTPB Standard Version 13 provides an industry-wide electronic standard for a real-time benefit tool (RTBT). The adoption of the standard meets CMS' requirements to advance price transparency and interoperability as required by Section 6062 of the SUPPORT for Patients and Communities Act. It also aligns with the Patients over Paperwork initiative.
How to Prepare and Plan for Implementation:
NCPDP has developed resources to support industry education, adoption, planning and implementation of the standards. These are opportunities to learn from the experts - NCPDP and its member leaders who participated in the development of the standards.
- Webinar: NCPDP SCRIPT V2023011 What is Changing, What to Expect and What to Do About It, September 24, 2024, 12:00 p.m. ET. Register at https://ncpdp.org/Webinars.aspx
- Webinar: NCPDP Real-Time Prescription Benefit (RTPB) Standard Highlights, September 10, 2024, 12:00 p.m. ET. Register at https://ncpdp.org/Webinars.aspx.
- NCPDP's 2024 Educational Summit: The online event takes place October 16 and 17, 2024. Each day will feature a half-day of programming that will dive into the details of how to prepare for implementation of NCPDP's SCRIPT Standard Version 2023011, its Formulary & Benefit Standard Version 60, and its Real-Time Prescription Benefit (RTPB) Standard Version 13. Registration will open in July 2024. To join an interest list and be among the first to register for NCPDP's 2024 Educational Summit, contact: [email protected].
About NCPDP
The National Council for Prescription Drug Programs (NCPDP) is a not-for-profit American National Standards Institute (ANSI) Accredited Standards Developer (ASD) consisting of more than 1,500 members representing entities including, but not limited to, claims processors, data management and analysis vendors, federal and state government agencies, insurers, intermediaries, pharmaceutical manufacturers, pharmacies, pharmacy benefit managers, professional services organizations, software and system vendors and other parties interested in electronic standardization within the pharmacy services sector of the healthcare industry. NCPDP provides a forum wherein our diverse membership can develop business solutions, including ANSI-accredited standards and guidance for promoting information exchanges related to medications, supplies and services within the healthcare system.
NCPDP has been named in federal legislation, including HIPAA, MMA, and HITECH. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for ePrescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. Our data products include dataQ®, a robust database of information on more than 80,000 pharmacies, resQ™, an industry pharmacy credentialing resource, and HCIdea®, an innovative prescriber database that provides continually updated information on more than 3.7 million prescribers. NCPDP's RxReconn® is a legislative tracking program for real-time monitoring of pharmacy-related state and national legislative and regulatory activity. For more information about NCPDP Standards, Data Services, Products, Educational Programs and Work Group Meetings, go online at http://www.ncpdp.org or call 480.477.1000.
Media Contact
Janet Cabibbo, NCPDP, 480-477-1000 x104, [email protected], www.NCPDP.org
Maggie Bruce, NCPDP, 480-477-1000 x144, [email protected], www.NCPDP.org
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