Pharmacy Groups Standardize Rx Claim Messages

Pharmacy Times, Volume 0, 0

Thanks to an agreement by 3 of thelargest pharmacy groups, third-partyprescription claims by pharmacists willget easier. The National CommunityPharmacists Association, the NationalAssociation of Chain Drug Stores, andAmerica's Health Insurance Plans havereached an understanding on standardizedelectronic messaging. The messageswill assist pharmacists and betterserve beneficiaries when they haveprescriptions filled at the pharmacy.

"I want to be clear that Medicare nowviews these consistent messages as bestpractices for the drug benefit, and weexpect the entire industry to adopt andimplement these practices as soon aspossible," remarked Mark McClellan, MD,PhD, administrator for the Centers forMedicare & Medicaid Services (CMS)."CMS will be looking at these and otherbest practices as measurements of planperformance?we expect these messagesto become requirements with theadoption of these standards by NCPDP[National Council for Prescription DrugPrograms], and we will be monitoringwhether we need to take further steps tomake sure that happens."

Specifically, the pharmacy groupsdeveloped standarized electronic messagesto help pharmacists quickly determinethe right course of action for fillingpatients'prescriptions, with a focus on 4critical areas: (1) when a particular drug isnot covered; (2) when prior authorizationis required; (3) when plan quantity or othercoverage limitations have been exceeded;and (4) when the pharmacy is not contractedwith the Part D plan's network.