NCPDP
Collaborative, consensus-building process involving members from Pharmacy, Pharma, Payer and Provider, Vendors, Government organizations
What is National Council fro Prescription Drug Programs (NCPDP)
List of drugs a plan has agreed to cover, usually divided by drug class and/or drug tier
What is a formulary
Product not covered
What is rejection code 70
ePAP
What is electronic Patient Assistance Program
We treat people like adults and always behave with ethics, integrity and honesty that are beyond question
What is Do the Right Thing
40 years
What is how long NCPDP has existed
Formulary is also known as
What is a Preferred Drug List (PDL)
Plan limitations exceeded
What is rejection code 76
eIV
What is electronic Insurance Verification
We recruit and promote people who want to win as part of a great company. We check our own egos at the door and win as a team
What is Be Selfless
NCPDP Universal Patient Identifier
What is one of NCPDPs current strategies focused on the patient
On-formulary recommendations are provided to the Provider
What are Formulary Alternatives (FormAlt)
NDC indicates a __________ not covered
What is a drug
A six digit classification system for medications, specific to Medi-Span, unique to each product
What is Dispensable Drug Identifier (DDID)
Achieving our mission requires us to do things we have never done before. We embrace this, knowing there is not an easy answer or someone that will tell us what to do
What is Embrace Challenges
Provides a venue for members and other industry stakeholders (members and non-members) to work together to create solutions for healthcare
What are NCPDP Work Group meetings
Similar to Formulary Alternatives, therapeutic recommendations are provided to the Prescriber
What is Generic Alternatives (GenAlt)
Prior authorization required, drug requires a PA for dual eligibility
What is rejections code 75
14-character classification system for medications, specific to Medi-Span, shared among several products with the same active ingredient, form and strength
What is Generic Product Identifier (GPI)
We care intensely about the achievement of our numbers, milestones and product excellence. No strategy, process organization, team or person is sacred if we are not getting the job done
What is Results Matter
When a claim is rejected and the Pharmacy initiates the PA request
What is a retrospective process
Used when a drug requested is on a higher cost-tier (non-preferred) than other similar drugs. Providers must give reasons why a lower-cost drug is not acceptable
What is Tier Exception
A 10 or 11 digit classification system for all medications which indicate manufacturer/distributor/re-packager, drug product/dosage, and package size
What is National Drug Code (NDC)
A non-profit standard development organization that provides business solutions through education and standardization. Has developed standards for eRx and ePA transactions
What is National Council for Prescription Drug Programs (NCPDP)
Our work is serious but we should never take ourselves too seriously. We never confuse activity or effort with results, and we are not afraid to goof off
What is Be Yourself