Data standardization is often cited as a common problem for patients and providers when selecting and discussing treatment options, according to a panel discussion at the 2020 National Association of Specialty Pharmacy (NASP) Annual Meeting and Expo.
The panel consisted of J.W. Hill, MBA-HCM, CNED, executive vice president and general manager of National Council for Prescription Drug Programs (NCPDP); Lynn Pezzullo, RPh, senior director of quality innovation at Pharmacy Quality Alliance (PQA); and Luis Rodriguez, president of Keycentrix. Each panel member had the opportunity to discuss and share their views on possible solutions to data standardization.
Mr Hill kicked off the discussion by explaining a little about NCPDP. He highlighted how the organization is a standards development organization accredited by the American National Standards Institute and has roughly 1500 members who are volunteers that fall into three categories. They are:
- producer-provider;
- payer-processor; and
- general interest.
“As we evaluated what kind of task groups, we wanted to support in our specialty space, we understood that there about 6 billion transactions prescribed annually. And, by the year 2024, there will be about $420 billion in drug spend,” Hill said. “So, we know that America is taking more drugs and we also know that Americans are taking more specialty drugs.”
According to Mr Hill, NCPDP created the Specialty Pharmacy Data Exchange Task Force. The task force was developed because specialty pharmacy has unique challenges regarding processing and the patient journey. The task force aims to assess reporting requirements, documentation requirements, and exchange requirements for all specialty pharmacies, pharmacy benefit managers, data aggregators, hubs, and manufacturers. The hope is that the task force will address the lack of a universal definition of specialty pharmacy; a lack of universal reimbursement, dispensing, or administration models; and the existence of a newly created category of medications called limited distributions drugs.
Following Mr Hill, Ms Pezzullo explained that she participated in the NCPDP task force regularly. She noted that her participation helped inform her of the understanding of the data standardization path. Further, she said that at PQA, similar challenges surrounding data standardization have been identified. PQA tests specialty pharmacy turnaround times (SP-TAT) measures. She explained that this was created in order to assess the average number of days between a specialty pharmacy receiving a new prescription for a specialty medication and the prescription being ready for pick-up or scheduled for delivery.
The findings of the SP-TAT showed that a lack of established, standardized performance metrics; the desire for outcome measures; highly variable, non-standardized data sources; insufficient interoperability; differing specialty pharmacy models; and numerous dispensing and care management systems were all challenges to efficient turnaround time in a specialty pharmacy.
“[M]any systems are configurable, which really is a benefit to meet individual specialty pharmacy needs, but also can pose a challenge when trying to define standardized data fields and data elements toward measurement,” Ms Pezzullo said.
The final panelist, Mr Rodriguez took time to explain ways that technology can help in ensuring data moves and flows in the proper direction. Although, he did say that challenges for technology stakeholders do exist. They often hinger the engagement in the acceleration of these standards.
According to Mr Rodriguez, the challenges to the adoption of any standard by a technology stakeholder include: incentives of a capitalist system that place a heightened importance on the role of supply and demand; the presence of unfunded mandates from non-legal entities; a lack of support from a strong member body that can push standards to the “optional zone;” and the existence of multiple standards bodies that can cause overlap for systems providers.
Although there are multiple standards like NCPDP and PQA that are important, Mr Rodriguez said they are now always aligned with one another.
“When you have all of them very enthusiastic about their standard and the implication it has on health care and the patient, you can kind of be tossed in different directions, and that can be difficult,” Mr Rodriguez highlighted.
He noted that these challenges can be overcome, however.
Mr Hill noted that there are some actions that could enhance workflow. He said these efforts include: SCRIPT, electronic prior authorization, risk evaluation and mitigation strategies enhancements, and efforts to advance real-time benefits information.
According to Mr Rodriguez, “Challenges can be overcome. It takes concerted effort, of course, it takes finding the right partners, finding the right body and the right network, and just being disciplined about that”—Julie Gould
Hill JW, Pezzullo L, Rodriguez L. A Push for Data Standardization. Presented at: 2020 Virtual NASP Annual Meeting & Expo. September 16, 2020. Accessed September 23, 2020.
