This overview is excerpted from Manatt on Health, Manatt’s subscription service that provides in-depth insights and analysis focused on the legal, policy and market developments. For more information on how to subscribe to Manatt on Health, please reach out to Barret Jefferds.
On June 17, CMS and the Office of the National Coordinator for Health Information Technology (ONC) issued a final rule implementing new standards for e-prescribing under Medicare Part D. In the November 2023 Policy and Technical Changes to the MA and Part D proposed rule for 2025, CMS proposed the following policies, which are finalized in this rule:
- Adopting National Council for Prescription Drug Programs (NCPDP) SCRIPT standard version 2023011 for communication of a prescription or prescription-related information by January 1, 2028 (a year later than originally proposed)1;
- Requiring Part D sponsors to use NCPDP Real-Time Prescription Benefit Tool standard version 13 as the standard for real-time benefit tools supported by Part D sponsors, also by January 1, 2028 (also a year later than the 2027 implementation date originally proposed); and
- Requiring the use of certain NCPDP Formulary and Benefit standards for electronically transmitting formulary and benefit information from Part D sponsors to prescribers and dispensers.
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1 Entities that are involved in e-prescribing are able to implement version 2023011 or continue using NCPDP SCRIPT standard version 2017071 standards as of the effective date of this rule (July 17, 2024) until the currently-utilized SCRIPT standard version (version 2017071) expires for HHS use as of January 1, 2028. As of January 1, 2028, entities will be required to exclusively use NCPDP SCRIPT version 2023011.