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Understanding NCPDP D.0 Standards for Compound Medications: Key Changes and Impacts

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The NCPDP D.0 standard, transitioning from Version 5.1, introduces significant changes in the processing and reimbursement of compound medications. Known as "D-Zero," this standard mandates the inclusion of all active ingredients in a compound for coverage determinations, as opposed to the previous method which focused solely on the highest-priced ingredient. This update emphasizes the Multi-Ingredient Compound (MIC) logic, ensuring fair pricing and reimbursement for compounds. Notably, it also outlines specific compound prescription examples and guidelines for compliance deadlines.

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Understanding NCPDP D.0 Standards for Compound Medications: Key Changes and Impacts

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Presentation Transcript

  1. What is D.0? NCPDP Version D.0 Compound Medications

  2. Background

  3. D.0 – What is it? • NCPDP Telecommunication Standard Update – Transitioning from Version 5.1 to Version D.0 • Known by the industry as D.0 and pronounced "D-Dot-Zero", "D-Dot-Oh", or "D-Zero" • Standard developed by NCPDP directing how claims are to be transmitted to insurance • Original Deadline for Compliance: January 1, 2012 – Extended to March 31, 2012 and then again to June 30, 2012

  4. How does D.0 affect compounds? • Old Standard (Version 5.1) • Historically utilized the highest priced legend ingredient for the determination of payment • New Standard (Version D.0) • Also known as Multi-Ingredient Compound (MIC) logic • Will no longer accept single ingredient compound processing, adjudication, or reimbursement • Includes all ingredients utilized in the compound for determination of reimbursement and coverage

  5. Multi-Ingredient Compound Prescription • Active Ingredients: • Ketoprofen 10% • Baclofen 2% • Cyclobenzaprine 2% • Lidocaine 2% • Dispense 300 ml • Directions: Apply 1-2 pumps to affected area 3-4 times daily. • Refill: 5x

  6. Old Standard (5.1) Active Ingredients Inactive Ingredients Using the price of the most expensive ingredient (4.8 x 300ml): Cost: $1440.00* *A dispensing fee may be added ***These prices and quantities are for comparison use only and are not intended to represent actual compound prescriptions.

  7. New Standard (D.0) Active Ingredients Inactive Ingredients Cost of Ingredients: $86.94* *A compounding fee would be added ***These prices and quantities are for comparison use only and are not intended to represent actual compound prescriptions.

  8. Compound Pricing Examples

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