To support codifying information communicated via free text messages, NCPDP’s February 2022 ballot includes proposed enhancements to the Real-Time Prescription Benefit Standard. The changes include additional External Code List values for the Coverage Restriction Code field and the addition of a new data element for next available fill date.

The Coverage Restriction Code values relate to the RTPBC Benefit Restriction Codes in the CARIN Consumer Realtime Pharmacy Benefit Check Implementation Guide. Implementers’ crosswalks of NCPDP Coverage Restriction Code values to RTPBC Benefit Restriction Codes may need to be updated because of the addition of the following values:

73: Additional Fills Are Not Covered

79: Fill Too Soon

AG: Days Supply Limitation for Product/Service

AC2: Route of Administration Not Covered

In conjunction with a new coverage restriction code to indicate refill too soon, a new situational data element for next available fill date for the submitted product is proposed for the RTPB Standard. It is a way to communicate when the patient is eligible to receive a prescription refill in a discrete field instead of via a free text message.

Information about data element from NCPDP Data Dictionary:

Next Available Fill Date field (situational)

Definition: Date on which this prescription will have passed the plan's minimum consumption requirements and may be considered for dispensing.

Format: 9(8)

CCYYMMDD
CC=Century
YY=Year
MM=Month
DD=Day

Situation of Use: Required when prescription is not eligible for dispensing until a specified date.