New standards from the National Council for Prescription Drug Programs could drive changes that improve patient safety by optimizing drug therapy to reduce the risk of harm and improve health and well-being before a medication is dispensed.
Picture walking into a pharmacy to get a prescription filled without knowing the drug cost or even if the medication is covered by your insurance. Only when receiving the bill from your health plan do you discover that you can’t afford the medication. Your anxiety and distress grow as you’re forced to start a line of credit with your favorite corner pharmacy.
This is the way it used to be, as pharmacies provided a line of credit for patients that created an administrative and a cash-flow burden for pharmacies and a barrier to getting medications for the patient. The National Council for Prescription Drug Programs (NCPDP) changed this dynamic by creating pharmacy standards for electronic health care transactions. As a result of these standards, you can walk into a pharmacy today, pick up a prescription, and pay a co-pay on the spot or know immediately if the prescription is covered by your insurance, which ensures access to medications and improves patient-pharmacy engagement.
Today, it’s easy to see the value of these early transaction standards. But perhaps even more important is the work being done within our industry to leverage emerging science and technology in further developing, validating, and advancing the quality of care with new medication and patient safety initiatives.
For example, the NCPDP Foundation recently provided a grant to study the benefits of integrating and storing pharmacogenomic (PGx) data within pharmacy benefit manager (PBM) systems using the Telecommunication and SCRIPT RxChange NCPDP standards.1 This enables the system to provide real-time clinical alerts and flag any highly adverse or ineffective medications based on PGx data to ensure a patient has access to medications that work for them based on their genetic profile.
There is a significant opportunity to build on this work and dramatically advance patient safety beyond conventional drug-gene interactions by considering the impact of simultaneous multidrug interactions. According to the FDA, adverse drug reactions (ADRs) are the fourth leading cause of death.2 One type of preventable ADR involves the metabolizing or activation of medications through the cytochrome P450-mediated drug pathway.
Cytochrome P450 enzymes metabolize and activate many common medications, including some OTC drugs. Despite the availability of tools that assess simultaneous multidrug interactions through the cytochrome P450 pathway, these capabilities have only been adopted in some niche (albeit growing) segments of the health care market.
Wouldn’t it be amazing to further personalize a patient’s medication regimen by leveraging these capabilities in the form of a novel risk score that predicts a patient’s risk based on simultaneous, cumulative multi-drug interactions? Like PGx alerts, an alert based on cumulative risks associated with multi-drug interactions would inform clinicians of potential high-risk patients who need medication management attention.
Not only does this technology exist today, but it is accessible to integrate into PBM systems along with PGx data in a way that would help our health system personalize medication regimens, personalize drug coverage, and improve outcomes. Instead of adopting medication formularies that use a one-size-fits-all approach, health plans could assess cumulative medication risk, inclusive of pharmacogenomics data, to help optimize drug routines. If the analysis identifies a drug that could raise a patient’s risk and potentially harm them, alternative medications would be recommended to reduce harm and improve efficacy.
Our current health care system is falling short if prescribing a new medication leads to dizziness, a fall, a visit to the emergency department or hospitalization. Currently, our health care system does not assess PGx or cumulative effects of medications and how they interact in our body at the metabolic level as a standard of care.
New NCPDP standards could drive these changes and improve patient safety by optimizing drug therapy to reduce a patient’s risk of harm and improve their health and well-being before a medication is dispensed. This mitigates risks, improves quality of care, and drives down medical costs.
Research demonstrates the cost benefit among Program of All-Inclusive Care for the Elderly (PACE) organizations.3 PACE is an example of value-based care, with organizations following a capitated payment model.
The research compared PACE organizations that use an advanced risk mitigation approach with prospective medication reviews compared with PACE organizations that did not use this novel approach. There was a $5000-plus difference between the 2 groups in changes in year-over-year medical costs, favoring the group that uses the modern methodology.
NCPDP is continuing to revolutionize and standardize pharmacy transactions while bolstering patient safety. Through prospective analysis of all the medications a patient takes, there is opportunity to build on NCPDP’s efforts to further drive patient safety and value-based care.
About the Author
Mindy Smith, BSPharm, RPh, MHA, CMWA, is senior vice president, Government & Professional Affairs at Tabula Rasa HealthCare. She was recently elected as one of the NCPDP Board Members for 2023–2026.