FormularyIHE Pharmacy meeting - Den Haag

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IHE Pharmacy white paper

• Formularies in the pharmaceutical practice

• Formularies as set of data in softwares

• Formularies as services (definition of an IHE compliance)

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What we need

• Availability : updated information on the availability of the medications in the perimeter defined : country, hospital or anything else

• Substitution : which medication can be used in place of another : generics or proposal if unavailable

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2 types of formularies

• 2 set of data :

• Availability formulary

• Substitution formulary

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Already done in the WP

• Introduction

• Formularies in "paper-based" practice

• Use cases

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What we need to clarify and achieve

• Data / service Medicinal Product Dictionary / Formulary exchange

• An IHE definition of the IT service (not the data)

• A list of existing IDMP and IT formularies with examples of data sets

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What we have to add

• The substitution formulary

• with uses cases :

• generics substitution by pharmacist in "community"

• Proposal by pharmacist in "hospital" according to the Hospital Formulary

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Formularies in USA• Pharmacy Benefit Manager (PBM) use panels

of independent physicians, pharmacists, and other clinical experts to develop lists of drugs approved for reimbursement in order to encourage clinically appropriate and cost-effective prescribing;

• PBM clients always have the final say over what drugs are included on the formulary that they offer to their employees or members.

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NCPDP standards

Formulary is linked to

Benefits

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Formulary and Benefits versions

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FBS from v1.0 to v3.0

NCPDP Formulary and Benefit Standard

• NCPDP recommends the regulatory process be started to move from the NCPDP Formulary and Benefit Standard Version 1.0 to Version 3.0. The modifications to the standard are noted below.

• The recommended timeline:

o The regulation to be published in the June 2012 regulatory notification.

o The effective date to be 60 days from publication (August 2012).

o Entities may use NCPDP Formulary and Benefit Standard Version 1.0 or

Version 3.0 during the period of August 2012 through June 30, 2014.

This is the transition period.

o The compliance date is July 1, 2014 for NCPDP Formulary and Benefit Standard Version 3.0.

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Medication Formulary and

Benefits

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MFB transactions

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Discussion

• Addition ?

• Price OK but BILLING ?

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