Thursday, September 16, 2010

MDRP 2010 Conference - Successful Rebate Processing with NCPDP Standardization

Dan Hardin, Senior VP Public Sector & Resident Care Management – SXC Health Solutions and Chair - NCPDP

What do you do when you have a new drug coming to market (or an existing product that has repetitive UoM issues)? Contacting NCPDP should be one of your first steps.

This volunteer organization has over 1500 members who are ready to help you head off any problems you may have in the future. NCPDP was started as a way to streamline issues within the industry by creating standards of forms, processes, and other items that change from agency to agency and they continue that work today.

One of the groups they currently have is Work Group 2 which was created in an effort to have proper product identification. The group will help you to organize your product label, unit of measure, package documentation, and other items which could possibly have different interpretations of the same information across agencies. Without a mandatory billing unit standard across all agencies there will always be room for error. Having seen and worked with the various agencies and understanding that a pain patch could be considered one unit by CMS, part of one kit by FDA, and one part of a unit of 12 by the states, NCPDP can help you to understand those conversions.

What about a bottle of syrup that is 4 fl. oz. which also shows 118 mL on the bottle? They can help you to understand how that unit conversion being printed on the same bottle could confuse pharmacists. And if the state agency does not know your specific product, they might bill you for one claim at 4 units, another at 118, and yet another at 1 unit based on what the pharmacist has entered into their system. NCPDP can foresee this type of UoM issue and can advise you on how to update your label in a way that makes the issue less cloudy to all persons who handle your product information along the reimbursement route.

Remember, everyone’s goal is to ensure that our products are accurately billed, so that they are accurately paid. Let their volunteer groups help you to reach that goal.

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