To support codifying information communicated via free text messages, NCPDP’s February 2022 ballot includes proposed new data elements to the Real-Time Prescription Benefit Standard to communicate formulary status and preference level. This allows for the communication of the formulary status of both submitted product and alternative products to help understand pricing on the response.

Information about data elements from NCPDP Data Dictionary and External Code List:

Formulary Status field (mandatory):

Definition: Status of the drug within the formulary.

Format: x(2)

Value Descriptions:

Brand Preferred

Carve-Out

Non-Formulary

On Formulary

Preferred

Unknown

Non-Reimbursable without authorization

Non-Reimbursable

Preference Level field (situational):

Definition: If there are multiple alternatives for a given Source drug, this is the payer’s order of preference (a lower number equals greater preference).

Format: 9(2)

Situation of Use: Required when values for formulary status are non-formulary, on-formulary or preferred and preference levels exist. 1 through 99, lower is more preferred.

Value descriptions:

Least preferred

Ordered preference between least to most

Most preferred