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Pharmacy Outlook: Lee Ann Stember, NCPDP

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The chaos and uncertainty of the pandemic, a polarizing political climate and continued civil unrest have challenged us — as individuals and organizations — and given us the opportunity to learn, grow and even redefine who we strive to be in our new normal.

Lee Ann Stember

These are the times when we cling even closer to our core values which keep us focused on our purpose — to standardize the exchange of health care information to improve outcomes. The National Council for Prescription Drug Programs embraces the new year with renewed optimism and carefully balanced realism, ready to support the unexpected and the changing future of health care.

Planning for growth and ­uncertainty

In 2019 and the first quarter of 2020, our board of trustees was engaged in a strategic planning process that culminated in its first Three-Year Strategic Plan, which was approved in May. The plan incorporated feedback from the board of trustees, the executive team, industry visionaries and consultants, and NCPDP members.

NCPDP’s existing strategic priorities — Universal Patient Identifier (UPI), powered by Experian Health UIM and NCPDP Standards, Specialty Pharmacy, Real-Time Prescription Benefit (RTPB) Standard, and the NCPDP Standards-based Facilitators Model for PDMP, An Interoperable Framework for Patient Safety — were rolled into the plan. These priorities continue to be a focus, as the organization is committed to seeing progress for the benefit of patients.

The overarching strategic plan identifies objectives for achieving organizational excellence and continued progress in standards development and still provides the flexibility to respond to unplanned or emergent events.

The flexibility of NCPDP’s strategic plan was put to the test when the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) issued guidance authorizing pharmacists to order and administer COVID-19 tests authorized by the Food and Drug Administration. NCPDP’s Emergency Preparedness Task Group quickly convened a series of calls to develop guidance pharmacists needed in their expanded role of administering tests and other services during the pandemic. It continues its vital work to develop informed recommendations for the industry to use for vaccine dosing and administration.

Reimagining standards ­development

One of our top goals is to continue to be the recognized leader in standards development by providing the industry with relevant standards delivered in a timely fashion and achieving adoption of those standards.

What we have seen time and time again over the past 44 years is that the standards that stick — those that are adopted, implemented and used — have a few things in common. First, they are born of need: a business need in the industry, a government mandate or a recognized patient safety issue. Second, they need to meet the needs of stakeholders affected by the standard and be developed by consensus of those stakeholders. Third, they must conform to existing workflows to be adopted, used and useful.

NCPDP’s stake in accelerating its standards development process is to ensure that its standards can meet the needs of the evolving health care ecosystem, keep pace with new innovations and preserve interoperability in data exchange.

To that end, we are challenged to think creatively, exploring ways to move quicker and remain true to our process. We have made significant progress identifying processes in the creation and naming of a standard that are within NCPDP’s scope. This important step allows us to now investigate opportunities to tighten our process and time line.

One thing we know for sure is that the more people who are participating, the better the quality of our standards and the faster we can move to enhance them. Accordingly, we are working to expand our membership and active engagement in our task groups and work groups by key groups, such as manufacturers.

Heightened interest in value-based care

Providing support for value-based care (VBC) models to achieve the goal of enhanced patient outcomes is one of NCPDP’s strategic goals. It is a natural fit for NCPDP, putting the focus on quality of patient care and not on volume. There are a number of drivers for VBC, which will undoubtedly accelerate adoption of VBC models.

The pandemic has boosted provider interest in value-based agreements as risk mitigation strategy, as some hospitals and health systems had to forgo elective procedures to plan resources and surge capacity in response to the pandemic. Incorporating value-based arrangements is one way to help diversify revenue streams to provide some stability during the pandemic. While not all providers are ready to make the move, some report that they are receiving higher payments in VBC arrangements than in fee-for-service agreements.

On the government front, CMS continues to take bold steps to advance VBC. Just last fall, the agency focused its efforts on Medicaid, which covers almost 74 million people. CMS issued guidance to states to encourage adoption of any number of proposed models.

Operationalizing precision medicine

NCPDP’s goal with precision medicine is to operationalize data to help providers give personalized medicine care for their patients. There is a chasm between the potential of precision medicine and actually using it to achieve improvement in patients’ health journeys. It will require a combination of education, technology and standards, as well as special attention to all the unique aspects of personalized medicine, including its use, delivery and impact on patients.

Last year the American College of Medical Genetics and Genomics published “The interface of genomic information with the electronic health record: a points to consider statement of the American College of Medical Genetics and Genomics (ACMG).” Among other things, the document provides guidance and recommendations on storing and accessing genomic data, privacy and ethical issues, benefits, and areas of concern.

Of course, NCPDP has been tracking precision medicine and genomics for years, and we see the potential for improving patient care and health outcomes. We see tremendous potential in supporting pharmacogenomics, for example, to deliver the right medicine and the right dose for a specific patient. Our work in the next few years will be important to achieving our goal for the ultimate benefit of patients.

Continuing key priorities

As mentioned earlier, the four key priorities NCPDP had focused on in previous years continue to be at the forefront of our efforts. NCPDP’s RTPB Standard is an important clinical tool that provides transparency on patients’ out-of-pocket costs for medications and can improve adherence and patient engagement. It is also instrumental in speeding time to therapy, much like our work in Specialty Pharmacy, which has provided important guidance on the standards and transactions that can be used to facilitate access to specialty medications.

Most recently, NCPDP published a white paper with information on one of the early challenges in specialty pharmacy — determining whether a specific medication is covered by the pharmacy or medical benefit. The white paper also details existing standards to support specialty as well as gaps in standards and opportunities to continue to automate workflows to improve the patient journey.

The other two key priorities, UPI, powered by Experian Health UIM and NCPDP Standards and the NCPDP Standards-based Facilitator Model for PDMP, are intrinsically synergistic and foundational to the future of health care. Our UPI for patient matching and identification and our national Facilitator Model — an interoperable solution that provides real-time access to data to address challenges of the opioid epidemic, the COVID-19 pandemic and more — are ready-to-implement solutions. Together they can power a real-time, national database to meet urgent public health data infrastructure needs.

The standards and guidance we develop with and for pharmacists and other providers will usher in health care transformation that focuses on improving the patient experience and health outcomes. Together, we are certain to come through these periods of change stronger, more resilient and better equipped to support the future of health care for the benefit of patients and the industry as a whole.

Lee Ann Stember, president and chief executive officer at the National Council for Prescription Drug Programs.


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