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