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Pharmacy Outlook: Lee Ann Stember, NCPDP

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This year kicks off major events and activities for National Council for Prescription Drug Programs that will fortify our ability to effect change at a more rapid pace and scale in the near future. We took a step back in 2019 to assess where we are as an organization, where the industry is heading, and what we should be doing in order to remain a leader and a steward in supporting the future of health care.

Lee Ann Stember

This began with making our board of trustees, who are the guiding force of the organization, smaller, highly focused and more engaged. The process of right-sizing our board took more than five years to execute. Our members elected the right leaders — nimble, strategic thinkers — and we ensured balanced representation among all our membership classes.

Next, we took a 360-degree view of the industry in where it’s headed and our role within it. An analysis of industry activities, trends and collaborations was evaluated. We also surveyed our board and executive team on challenges and opportunities and ways to propel NCPDP forward in service to the industry and, importantly, to patients. A survey of our membership — as a member-driven organization — provided the final set of data needed to complete our ­assessment.

Why now?

NCPDP has a rich tradition of driving transformational change in the pharmacy services sector. Our impact reaches far beyond pharmacy and our reputation among industry stakeholders, including government agencies and on the Hill, has put our problem-solving forum and process in high demand.

What’s next?

Our short-term priorities remain firmly rooted in patient matching and identification; adoption and implementation of NCPDP’s RTPB Standard; implementation of our standards-based model for PDMPs to help address the opioid epidemic; and development of standards and enhancements to meet the unique needs of specialty pharmacy. Long term, we are considering ways to support major initiatives such as value-based care and the imperative to support precision medicine.

NCPDP RTPB Standard ushers in new era of prescription cost transparency

On November 15, 2019, the Centers for Medicare and Medicaid Services (CMS) issued two rules requiring hospitals and health plans to make their negotiated rates publicly available. The historic cost transparency requirements build on the CMS mandate that each Medicare Part D plan adopt one or more real-time benefit tools (RTBTs) that are capable of integrating with at least one prescriber’s e-prescribing system or EHR, no later than January 1, 2021. These ambitious reforms will fundamentally transform the provider-patient relationship by enabling meaningful conversations about covered and alternative treatment options based on the individual patient.

Consistent with CMS’ sweeping proposed mandates intended to empower patients, NCPDP members took an important step in August 2019 by approving the beta version of NCPDP’s RTPB Standard. It will standardize the instant availability of every patient’s real-time prescription drug information regardless of the insurer — all within providers’ workflows.

When finalized, we expect national adoption of NCPDP’s RTPB Standard to benefit prescribers and patients immediately. Prescribers will have informed conversations engaging their patients on treatment regimens and alternatives to select the best medication based on the individual’s needs. Patients will gain a better understanding of their covered treatment and options, and they will be more inclined to purchase the prescribed drugs instead of abandoning them, which accelerates time to therapy and improves medication adherence and outcomes. Pharmacists as well — who broadly enjoy trusted provider status among patients — will benefit from the ability to run a prescription benefit check using the standard, instead of actually submitting the claim before a patient’s out-of-pocket cost can be ­determined.

100% of U.S. population has a UPI, powered by Experian Health UIM and NCPDP standards

NCPDP is encouraged by the House of Representatives’ vote in June to end the 20-year-old ban on federal funding of a national patient identifier. We believe much work remains to be done, and we will continue our efforts to move patient matching forward as the legislative process unfolds in 2020.

Today, 100% of the U.S. population has been enumerated with the Universal Patient Identifier (UPI), powered by Experian Health UIM and NCPDP standards. This milestone achievement paves the way for improving patient safety. NCPDP has the unique ability to share the UPI throughout the pharmacy system and the entire health care ecosystem using the NCPDP Telecommunication Standard and the NCPDP SCRIPT ­Standard.

NCPDP and Experian Health have a “no charge offer” to the industry to help accelerate the benefits of the joint solution by reducing the complexity of matching and managing patient identities. By helping organizations improve the quality of their data, the solution addresses interoperability and financial and operational challenges, and it improves care coordination, efficiencies of population health management strategies and ­PDMPs.

Legislation cites NCPDP Standards-based Facilitator Model for PDMP

Opioid overdose deaths continue to increase in the U.S. According to the CDC, in 2017 more than 70,000 people died from drug overdoses, and of those deaths nearly 68% involved a prescription or illicit opioid.

PDMPs, the state-operated databases that collect information on dispensed medications, have evolved historically since the program was first enacted in 1939 in California to enforce drug laws. Still, the overall effectiveness of PDMPs is challenged by a lack of standards to share drug information within and across the states to address potential drug abuse and ­diversion.

Since 2013, NCPDP has maintained a priority focus on developing a solution to help address the epidemic. At that time, we took visionary action, publishing a white paper that details a standards-based model for prescription drug monitoring programs (PDMPs) with best-practice guidance to help providers make informed clinical decisions at the point of prescribing.

The NCPDP Standards-based Facilitator Model for PDMP, an interoperable framework for patient safety, prevents diversion, ensures appropriate access and protects patients. The model has received widespread support from stakeholder groups and has been widely heralded as a solution to address gaps in PDMP systems — specifically real-time exchange of information, interoperability and workflow, within and across state lines.

The model solution, which has been named in legislation, is intended to provide access for patients with a valid medical need and reduce fraud and abuse. We will continue to EDvocate for the model in the coming year.

NCPDP brings national awareness to specialty pharmacy initiatives

Committed to facilitating timely access to specialty medications for patients with chronic or complex conditions, NCPDP established a specialty pharmacy work group in 2018 to enhance and develop new standards and guidance that speed time to therapy.

Since then, the work group continues to support use of NCPDP standards and guidance that can help address the unique needs of specialty pharmacy: a white paper with best-practice guidance for Risk Evaluation and Mitigation Strategies (REMS); the Specialty Pharmacy Data Reporting Standard; specialty pharmacy enhancements in the new SCRIPT Standard Version 2017071, which CMS adopted effective January 1, 2020; electronic prior authorization transactions in the SCRIPT Standard; and the beta version of the RTPB ­Standard.

Additional work in process includes a benefit coverage identification white paper and a new task group tackling the challenges of managing patient consent, which impacts providers and patients and the time it takes for patients to begin therapy.

Looking ahead

In the future, we expect to see an increasing need to develop standards to support two longer-term areas of focus for NCPDP: the evolving value-based care and payment models, and the rapidly growing science of precision medicine that tailors personalized treatments to each individual’s unique genetic makeup.

Value-based care remains a priority for Medicaid managed care. In addition, a growing number of states have implemented alternative care models, signaling a trend with staying power.

NCPDP standards have transformed the pharmacy industry in saving billions of dollars in health care costs while increasing patient safety and care quality. Relatedly, we believe that NCPDP standards can offer provider organizations enrolled in value-based care programs a means to support their efforts to share pharmacy data and outcomes to earn incentive ­payments.

Specifically, value-based payment models use measures of quality and cost closely aligned to outcomes of care to determine payment for providers. Existing NCPDP standards and future enhancements can support interoperability and data collection, aggregation and sharing from multiple sources, and quality and accurate reporting to demonstrate better outcomes and costs.

NCPDP will also evaluate a potential role in developing unified standards to support precision medicine, a growing area of interest for health care providers. Yet, its enormous potential will be realized only when combining genomic and biological data with a holistic view of patients to enhance personalized care. Gaining insights about a person’s environment and lifestyle through collection of social determinants of health (SoDH) data is increasingly recognized as important to target treatments including medications and engage patients.

By employing this data, pharmacists and providers can inform and select the best targeted medication therapies and intervention strategies to improve patient care.

NCPDP members’ perspectives, knowledge and expertise are vastly critical to the standards development process and in planning ahead for future health care reforms and trends. NCPDP welcomes members and nonmembers to lend their experience and expertise to developing and enhancing industry standards. NCPDP work groups meet quarterly, in-person, at locations across the country, while task group calls take place between work group meetings. Join NCPDP at its Annual Technology and Business Conference, “Dream BIG | Act NOW,” May 4 to May 6 in Scottsdale, Ariz. For more information, visit ncpdp.org.

Lee Ann Stember is the CEO at the National Council for Prescription Drug Programs.


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