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May 2016, Vol 4, No 5 - Inside Pharmacy
Stephen C. Mullenix, RPh

The National Council for Prescription Drug Programs (NCPDP), a standards development organization (SDO), has served the pharmacy services industry for approximately 40 years. The organization—which has ushered in a real-time environment for this segment of the healthcare industry—has made a practice of putting its vision into action to transform a paper-based environment into an automated one, laying a foundation for the continued expansion of pharmacist-administered clinical services. Today, NCPDP’s work is as important as ever; with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) shift toward aligning Medicare reimbursements with quality and cost improvements, NCPDP’s clinical and administrative standards will be important tools for measuring, tracking, and reimbursing pharmacists’ direct patient care services.

Participation in NCPDP’s forums is vital, because it helps ensure that business, workflow and patient care needs of all stakeholders are considered in the standards development process. Furthermore, it provides an important educational component, enabling all stakeholder groups to share perspectives on issues, and learn how one action can impact other stakeholders. Issues are brought to NCPDP by its members, as well as government agencies and non-members, who are proactively identifying patient safety or business concerns. The outcomes of NCPDP’s consensus-building process can be industry standards, enhancements to existing standards, or guidance, usually in the form of a white paper or industry education. The inclusive, thorough, and rigorous process engenders adoption.

Actively Supporting the Pharmacy Practice

NCPDP has always been actively engaged in supporting the pharmacy practice. The organization’s Work Group 10 Professional Pharmacy Services (WG10) recently assessed its scope and goals to ensure that it addresses the evolving and potential future roles of pharmacists as valuable providers in the patient care team. WG10 goals, which support the range of pharmacist-provided patient care services (eg, immunizations, prescribing, patient monitoring services) and next generation of pharmacy practitioners, include:

  • Continuing to develop and enhance standards and implementation guides that improve the patient-centered care process, using interoperable information technology to facilitate communication among all individuals involved in the patient’s care
  • Work with pharmacy colleges to help incorporate health information technology and data exchange standards into the pharmacy curriculum
  • Work with Work Group 11 ePrescribing & Related Transactions to identify and address segments of pharmacy practice (eg, compounding, specialty, and home infusion) that may have unmet communication and information exchange needs.
The goals of NCPDP’s WG10 also align with the Joint Commission of Pharmacy Practitioners’ Pharmacists’ Patient Care Process, supporting continued development or modification of medication- and practice-related administrative and clinical standards.

Promoting SCRIPT Standard Transitions

In February 2016, NCPDP submitted a recommendation that the industry transition from NCPDP SCRIPT Standard Version 10.6 to SCRIPT Standard Version 2015071 between January 2017 and January 2019—with compliance in January 2019—to the Centers for Medicare & Medicaid Services (CMS). SCRIPT Standard Version 2015071 includes important technical and patient safety features that have been incorporated since Version 10.6 (eg, electronic prior authorization transactions). Other enhancements include updates to Structured and Codified Sig Format in response to members’ needs for additional implementation guidance, and support for compound prescriptions with fields for the final compound and individual ingredients.

Until the industry transitions to the NCPDP’s recommended version of SCRIPT, NCPDP and its members work to increase awareness, adoption, and implementation of the underused functionality in the standard. The healthcare industry is currently using SCRIPT Standard Version 10.6, which contains 13 transactional exchanges for electronic prescribing functions, some of which are named in the regulations associated with the Medicare Prescription Drug, Improvement, and Modernization Act. In addition to transmitting a new prescription, the standard allows for changing and canceling a prescription; renewals and resupply exchanges; fill status notifications; transmitting medication history; and census exchanges. More robust implementation of these transactions can improve administrative efficiencies for pharmacists and prescribers, speed time to therapy for patients, streamline care coordination and medication management; and aid in tracking and measuring patient health outcomes.

Prioritizing Coordination of Standards

Harmonizing standards and working with other SDOs is also a priority for NCPDP. One project resulting from collaboration other SDOs is the development of an electronic Pharmacist Care Plan. The plan is based on templates in Health Level Seven’s (HL7’s) HL7 Implementation Guide for C-CDA Release 2.1: Consolidated CDA for Clinical Notes. The Pharmacist Care Planinvolves medication-related activities and services, such as medication therapy management, clinical reconciliation (medication, allergies, and problems), immunization management, disease state monitoring, and therapy adherence programs. It supports interoperability, and the integration of pharmacy clinical services into the National Interoperability Roadmap, as well as the CMS Medicare Part D Enhanced Medication Therapy Management model, and the move toward value-based payment models.

Several years ago, NCPDP founded the Standards Charter Organization, recently renamed as the Health Standards Collaboration.1 The Health Standards Collaboration, chaired by NCPDP, is a formal collaboration among United States healthcare standards development organizations. It is composed of various healthcare standards development organizations, including HL7 International, Accredited Standards Committee X12, ASTM, and Clinical Data Interchange Standards Consortium, in addition to other standards-related entities and formal observers.

As NCPDP envisioned, the Health Standards Collaboration has the potential to play a pivotal role in supporting new strategies for improving interoperability and the use of technology to support patient-centered, value-based care. Health Standards Collaboration discussions on the importance of standards led to an ONC grant, the Standards Development Organization Collaboration to Enhance Standards Alignment, Testing, and Measurement project, which was awarded to NCPDP. The grant seeks to ensure that standards are tested, measured, and used as intended to facilitate interoperability and workflow efficiency.

Focusing on the Patient

At the core of all of NCPDP’s work is the best interest of the patient. Increasingly, NCPDP has been called upon to address issues that do not necessarily result in an industry standard or enhancement to a standard. Most recently, NCPDP approved the white paper, Recommendations for Dose Accumulation Monitoring in the Inpatient Setting. The white paper addresses higher-than-therapeutically-necessary dosing for hospitalized patients, which can occur even with robust clinical decision support tools and alerts to detect inappropriately high ordered dosages and duplicate therapies. The white paper, which will be released in 2016, examines gaps in systems and processes at care transitions, and includes recommendations targeted at reducing patient risk for overdose. Another recent patient safety white paper is the NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications.2

EDvocacy is also an important strategic initiative for NCPDP.3 It communicates the value of bringing all healthcare industry stakeholders together via the organization’s forums to create sustainable industry solutions to challenges in business and patient safety, to improve healthcare outcomes. EDvocacy focuses on education, and sharing knowledge of healthcare system complexities; an understanding of the impact change has on each stakeholder group; the importance of consensus-building, sacrifice, and investment in serving the industry’s greater good, and, more importantly, benefiting patients; real world solutions for improving healthcare; and the forum and process for leading and keeping up with evolving industry needs.

EDvocacy is expressed at all levels of the organization, including by NCPDP’s Industry Relations team, executive staff, Strategic Planning Committee members, and Board members, who participate in meetings with industry leaders and policymakers to educate and raise awareness of NCPDP, and serve as a trusted, knowledgeable resource.3

As part of its EDvocacy initiative, NCPDP meets regularly with other associations to better understand their goals and priorities, share NCPDP’s work, and explore synergies across organizations. In the past year, NCPDP presented to and met with the National Association of Chain Drug Stores; ONC S&I Framework; American Academy of Family Physicians; National Alliance of State Pharmacy Associations; Western Medicaid Pharmacy Administrators Association; United States Pharmacopeial Convention; Office of National Drug Control Policy; and National Governors Association.

On an international level, NCPDP has participated in meetings of the International Pharmaceutical Federation (FIP). In August 2016, the organization will deliver a presentation on patient safety standards and interoperability at the 76th FIP World Congress of Pharmacy and Pharmaceutical Sciences in Buenos Aires, Argentina.

NCPDP’s highest organizational priority is the prescription drug abuse epidemic. It has sustained a 3-year commitment to addressing the epidemic, simultaneously ensuring access for patients with a valid medical need and averting potential fraud and abuse. The solution takes a best practice approach, and uses the interoperable infrastructure of federally mandated standards.

NCPDP’s PDMP Solution has garnered such tremendous industry and legislative support that the solution has been propelled to its next level; NCPDP has developed detailed documentation on the implementation steps, role of the PDMP Facilitator; role of state PDMPs and how to optimize their programs, and safeguards to uphold privacy protections. In addition, NCPDP is currently in discussions with potential participants to pilot the solution. NCPDP’s goal is to have its PDMP Solution implemented in the next 5 years.

The Importance of NCPDP

Participation in NCPDP is more important than ever. The organization’s consensus-building model works and continues to drive profound transformation in the industry. NCPDP is where competition gives way to collaboration to work for the greater good; it is the framework for an interoperable, learning health system, and the place where people can get the best education about the workings of the healthcare system, while influencing the future direction of the industry.




References

  1. NCPDP Announces Name Change for SCO, Reflecting Resurgence of Collaboration Among Healthcare Standards Organizations [news release]. Scottsdale, AZ: National Council for Prescription Drug Programs; April 26, 2016. www.prweb.com/releases/2016/04/prweb13365848.htm. Accessed May 13, 2016.
  2. National Council for Prescription Drug Programs. NCPDP recommendations and guidance for standardizing the dosing designations on prescription container labels of oral liquid medications. www.ncpdp.org/NCPDP/media/pdf/wp/DosingDesignations-OralLiquid-MedicationLabels.pdf. Published March 2014. Accessed May 13, 2016.
  3. National Council for Prescription Drug Programs. NCPDP EDvocacy initiative. www.ncpdp.org/About-Us/EDvocacy. Accessed May 13, 2016.
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