NCPDP

Background |  Areas of Current Investigation

Background

The National Council for Prescription Drug Programs (NCPDP), an American National Standards Institute (ANSI) accredited Standards Developing Organization (SDO), is responsible for the continued development and maintenance of the NCPDP standards for pharmacy services messaging. The NCPDP standards include several syntaxes used in the exchange of pharmacy information, such as:

  • Telecommunications Standard - used for eligibility communications between retail pharmacy dispensers and payers/pharmacy benefit management companies (PBMs).
  • SCRIPT Standard - used to transmit electronic prescriptions from a physician or prescriber to the pharmacy; specific messages include New, Change, Renewal, Cancellation, and Fill Status.
  • ASC X12N-2701/271 Eligibility and Benefit Standard - used for eligibility and benefits communications between dentists, professionals, institutions, and health plans.
  • NCPDP Formulary and Benefit Standard - provides patient benefits information to physicians at the point of care.

NCPDP also maintains and updates the Provider Identification Number (Provider ID) database, the source of identifiers that accurately identifies pharmacies in electronic transactions.

Past Activities

On November 1, 2005, HHS Secretary Mike Leavitt announced the adoption of standards for electronic prescribing (e-prescribing) of Medicare Part D drugs. The proposed standards, published in the Federal Register (Vol. 70, No. 214), are aimed at making prescription drugs easier and safer for Medicare beneficiaries to receive. Three NCPDP standards were among those named: NCPDP SCRIPT Version 5.0, ASC X12N 270/271 Version 4010A1, and NCPDP Telecommunication Standard Version 5.1.

In December 2005, AHRQ awarded four cooperative agreements and one contract to test and evaluate the interoperability of potential e-prescribing standards. The five projects carried out pilot studies in 2006 and measured the effectiveness of the proposed HHS messaging standards for e-prescribing, specifically looking into their transmission accuracy, impact on quality of care, and interoperability with NCPDP foundation standards. The evaluation report (PDF, 2.13 MB) , published in 2007 by AHRQ and the National Resource Center, recommended that the medication history, formulary and benefits, and prescription fill status indicator standards were ready for implementation under Part D. Prior authorization, structured and codified signature (sig), and the RxNorm standards were not ready for implementation in their current state.

In December 2005, NCPDP and Health Level Seven (HL7) completed the first phase of a project to streamline e-prescribing messaging capabilities between prescribers and pharmacies and payers. As explained in an HL7 press release, the two groups completed a mapping guidance document to help implementers create e-prescribing messages "for new prescriptions, changes to prescriptions, refills (renewals), cancellation of a prescription, compliance notification, and the sharing of medication history information" (PDF, 42 KB) . The document is available from either HL7 or NCPDP, but only members of these organizations can currently download the document.

Areas of Current Investigation

On April 7, 2008, The Centers for Medicare & Medicaid Services (CMS) issued a final rule (see Federal Register, Vol. 73, No. 67) adopting the National Provider Identifier (NPI) as a standard "for identifying health care providers in e-prescribing transactions." The NPI is a unique identifier assigned to all prescribers and pharmacists electronically transmitting prescriptions for Medicare Part D. The final rule issued by CMS also identified NCPDP SCRIPT version 8.1 as the accepted standard for "communicating prescription or prescription related information between prescribers and dispensers." It is expected that industry will move to SCRIPT version 10.5 by 2010.

In the Federal Register on August 22, 2008, HHS released the NCPDP standards for the next round of Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance. Among the NCPDP standards named are the ASC X12N 270/271.

For projects related to e-prescribing and for other resources, refer to the Electronic Prescribing Key Topics Page.