NCPDP Real-Time Prescription Benefit Task Group: Why Stakeholders Need to Take Notice

September 11, 2018  |  Jessica Behrendsen

A provider with a family

Patient transparency and solving the problem of provider visibility at the point of prescribing is seemingly everywhere right now. With the release of the 2018 Real-Time Benefit Check National Adoption Scorecard, we thought it would be a good opportunity to provide an overview of the work the National Council for Prescription Drug Programs (NCPDP®) is doing to align on standards around what they refer to as the Real-Time Prescription Benefit (RTPB) task group, and why it’s currently one of their number one initiatives.

What is a task group and what are the goals of RTPB?

For NCPDP, a task group is a collaborative initiative across the industry to align on standards around a specific product or solution. Each task group is open to any group or individual interested in bringing their perspective and expertise to ensure full representation of stakeholders. It is not a requirement that task group participants be a member of NCPDP; however, if a vote is taken non-members are not allowed to cast a vote during quarterly meetings.

The RTPB task group is in the process of developing two standard formats and one implementation guide for the “real-time exchange of data between providers and the PBM.”1 This will include establishing patient eligibility, medication coverage and benefits for the product, as well as identifying coverage restrictions and product and benefit alternatives when available.

There are 12 use cases being developed by the task group listed as follows:

  1. Patient Eligible, Product Covered
  2. Patient Not Eligible
  3. Benefit Exclusion
  4. Formulary Exclusion
  5. Coverage Limits
  6. Step Therapy Required
  7. Prior Authorization Required
  8. Out-of-Network Pharmacy
  9. Out-of-Network Provider
  10. Patient/Provider Lock-in
  11. Patient Due Alert
  12. Restricted Pharmacy

For detailed descriptions of use cases, you can visit this link and register for free. The task group currently does not include use case elements such cash price, electronic vouchers and availability of patient assistance programs.

What is the importance of the task group and why should all industry stakeholders join the conversation?

One of NCPDP’s main goals is to get the NCPDP RTPB task group named at the federal level and will be moving on the initiative as early as February 2019. Once something is named, stakeholders across the board want to be compliant with the data elements in the standard, so it’s important to get involved now to ensure all use cases are accounted for.

While the standard can be changed as the industry evolves, elements that are important to stakeholders (including payer, pharmacy, pharma and providers) need to be addressed. Whatever transpires at the federal level, it has the ability to improve the landscape of speed to therapy.

The end game for RTPB is patient adherence, which is why it’s one of their top strategic initiatives — to get the patient quicker access to their medication at a price they can afford. If your organization cares about this goal, you need to be paying close attention to RTPB.

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