What is D.0? NCPDP Version D.0 Compound Medications Background 1977 1978 1987 • NCPDP was founded (National Council for Prescription Drug Programs) • UCF established (Universal Claim Form) – First standardization effort • PCS introduced electronic claims 1988 • NCPDP developed version 1.0 of the Telecommunication Standard for online, realtime claims processing 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", "DDot-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 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 Multi-Ingredient Compound Prescription • Active Ingredients: – – – – Ketoprofen Baclofen Cyclobenzaprine Lidocaine 10% 2% 2% 2% • Dispense 300 ml • Directions: Apply 1-2 pumps to affected area 3-4 times daily. • Refill: 5x Old Standard (5.1) Active Ingredients Inactive Ingredients Ingredient AWP per gram/ml Ketoprofen $0.64 Baclofen $4.00 Cyclobenzaprine $4.80 Lidocaine $0.56 Ethoxydiglycol $0.06 Lecithin $0.03 Isopropyl palmitate $0.03 Pluronic F-127 30% Solution $0.05 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. New Standard (D.0) Active Ingredients Inactive Ingredients Ingredient Amount Total Ketoprofen 30g $19.20 Baclofen 6g $24.00 Cyclobenzaprine 6g $28.80 Lidocaine 6g $3.36 Ethoxydiglycol 30ml $1.80 Lecithin 33g $0.99 Isopropyl palmitate 33ml $0.99 Pluronic F-127 30% Solution 156ml $7.80 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. Compound Pricing Examples Retail Pharmacy Amount Carlisle Mail Order Pharmacy Amount Date of Service Compound 5/24/2012 Compound 1 Knoxville, TN $11,942.32 $2,916.00 $9,026.32 6/11/2012 Compound 2 Nashville, TN $12,722 $2,916.00 $9,806.40 6/25/2012 Compound 3 Fort Walton Beach, FL $835.87 $209.25 $626.62 6/27/2012 Compound 4 San Francisco, CA $1,186.07 $125.55 $1,060.52 7/26/2012 Compound 5 Jackson, MS $2,823.47 $1,461.38 $1,362.09 8/21/2012 Compound 6 Grayson, GA $1,092.51 $209.25 $883.26 Claimant Location Savings