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x12.org

X12 is pleased to distribute this survey to X12N constituents on behalf of NCPDP, our long-time trusted and collaborative organization. NCPDP and X12 believe that gathering input from a broad range of diverse industry stakeholders provides valuable information as the SDOs work cooperatively to identify effective and efficient solutions that positively impact the health care industry. I encourage you to review NCPDP’s survey and provide thoughtful responses to inform industry guidance and possible enhancements to current industry standards. NCPDP Work Group 18 Specialty Pharmacy’s Benefit Coverage Identification Task Group is focused on finding efficient ways to determine if the medical or pharmacy benefit should be utilized for a prescription medication. Providers often struggle to know how certain specialty medications will be covered by payers. Currently there is not an efficient way to electronically verify this detailed coverage information. The task group created a survey to gain an understanding of the resources and time required to verify pharmacy benefits and medical drug benefits for a patient. Based on the survey results, the task group hopes to create industry guidance based on the transactions that exist today and to explore possible enhancements to those existing transactions to improve the verification process in the future. NCPDP appreciates you taking the time to respond to the survey, and we look forward to sharing the applicable feedback with X12 to improve the exchange of information to support timely access to patient care. Please complete the survey by 02/28/2022.

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