NCPDP 2018: Spotlight on Specialty Pharmacy, New Standards, and Improving Patient Experience

Monday, May 21, 2018

Marsha K. Millonig, MBA, BPharm

NCPDP, the standards development organization focused on the pharmacy sector, just wrapped up its annual business and technology conference, which immediately followed its quarterly technical work group meetings.

NCPDP is responsible for the creation and maintenance of messages used to exchange electronic prescription and related claims information, and a key outcome of the technical work group meetings was the creation of a new work group focused on the specialty pharmacy segment. After several meetings of stakeholders to discuss challenges and opportunities facing the exchange of information in this sector, this new work group will focus on driving transaction automation. Among its proposed goals are:

  • Developing new standardized transactions and messages for prescribers, pharmacists, payers, and/or other interested parties in exchanging information related to specialty prescriptions.
  • Identifying pain points and transactions that delay the prescribing, dispensing, reporting, and payment of specialty medications.
  • Determining if an electronic transaction and/or standard can be used to improve the process.

NCPDP members are also preparing to transition to a new version of the SCRIPT Standard, as mandated by the Centers for Medicaid and Medicare Services (CMS). This transition will improve the ability of the industry to exchange prescription-related information, and the new version reflects enhancements brought forward based on business needs.

Conference Highlights

At the conclusion of the technical work group meetings, attendees focused on two days of educational programming, presented in professional and technical tracks and keynote speakers. 

The professional tracks included sessions on:

  • Prescription Drug Monitoring Programs (PDMP) legislative and regulatory trends and how these changes will impact pharmacy
  • Specialty drug management in the age of consumerism
  • Changes in community care, value-based payment models, and implementation of the Pharmacist eCare Plan

Also popular were sessions on legal updates around the pharmacy benefit industry and their impact on patients and looking at ways to leverage various types of Medicare data (Parts A, B, C and D) to impact outcomes and adherence.

The technical tracks also addressed a range of timely topics of interest to attendees, including:

  • The use of MTM Audit Findings to identify opportunities and anticipate future program changes
  • How electronic prior authorization (ePA) can be used to improve patient’s access to therapy and adherence
  • Using standardized data to advance pharmacy practice and support interoperability
  • Advancing population health through interoperability
  • The value of protected health information (PHI) and how to protect data from unauthorized users
  • The opportunities of telehealth to engage at-home, at-risk patients

The keynote speakers also addressed a range of topics, from tactical to motivational, that provided attendees with practical ideas to take back to their daily lives. This began with the opening panel, moderated by Dr. Walter Suarez, executive director of health IT strategy and policy at Kaiser Permanente, as they discussed “Data Challenges and Opportunities to Improve the Patient Journey.”

Among the panelists who joined Dr. Suarez was Regina Holliday, a patient rights activist, artist and author, who, as a keynote speaker, also presented an incredibly moving story of the challenges faced by her late husband, as he was hospitalized at five different facilities in 11 weeks. She clearly understands the impact of health information technology on the patient experience and has presented that verbally and visually through murals and the creation of the “Walking Gallery.” This gallery paints patient stories onto the backs of providers and advocates, inviting discussion. Her presentation reminded attendees that any of them could have been in her shoes, struggling to advocate for a loved one, and that they have a role to play in improving the accessibility of health information. The visceral emotions she evoked lingered with attendees throughout the conference and likely are still with them.

Former U.S. Chief Technology Officer, Aneesh Chopra, discussed “Open Data, IT, and Value-Based Payment.” The session looked at recent efforts to improve data access among providers, payers, and the government; how these efforts impact consumers, including their ability to take a more active role in making informed decisions; identified a potential path for healthcare organizations to develop the foundation for securely organizing, enhancing and sharing patient data; and talked about the impact of this work in an uncertain policy environment.

Perennial NCPDP attendee favorite Doug Long, vice president of industry relations for IQVIA, gave his highly anticipated “Market Trends Report.” This session is always jam-packed, with attendees and with dozens of critical data points about changes in the marketplace. His presentation included identification of factors that influence healthcare costs; notable developments in the brand, generic and specialty drug markets; current market leaders by therapeutic class (and those that have declined); and a look at developments that will likely influence the pharmaceutical and managed care markets over the next 12 months.

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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