At the February 2023 WG2 Meeting the form was discussed.
Clarification of Billing Unit Standard
New Product/Package Information
Eli Lilly and Company (Lilly) requests NCPDP’s assistance to determine consistent and accurate billing for a forthcoming refill kit containing various diabetes supplies. Lilly would like to confirm that NCPDP’s “kit” definition would be applied to their soon-to-launch product. Lilly also requests insight on the billing quantity that would be assigned.
The Refill Kit is expected to contain the following:
100 blood glucose test strips
100 pen needles
2 gauze pads
Lilly’s refill kit is not meant to be broken; the pharmacy is to dispense the package as is. The refill kit does not contain a blood glucose meter.
The request is needed to ensure that a consistent and accurate billing unit and quantity are submitted to the drug pricing compendia providers at the time of product launch. Lilly wishes to avoid pharmacy and payer confusion as it relates to the dispense quantity for the refill kit.
The Billing Unit Standard 5.5.1 states that “Kits are defined as products that contain one of the following:
1) at least two distinct items with different billing units
2) one product packaged with medicated or unmedicated swabs, wipes and/or cotton swabs/balls
3) meters packaged with test strips”
Lilly anticipates that the Refill Kit meets NCPDP’s definition of a kit and that NCPDP will confirm that a quantity and billing unit of “1 each” is appropriate.
Task Group Discussion (11/29/22):
WG Discussion (02/02/23):
- The kit contains 100 test strips, 100 pen needles, 100 lancets and 2 gauze pads it is not intended to be broken and the pharmacy is to dispense it as is
- A glucose meter is not included in this package
- Eli Lilly has included gauze pads in the packaging therefore per section 5.5.1 of the BUS this makes the product a kit
- This is a refill kit that will be used with the Tempo system
- A Tempo kit was released without the gauze pads and that package is billed as 300 each
- The new kit will be revised with a new NDC number
- Eli Lilly recently submitted an NDC with lancets, pen needles and test strip and no gauze pads are included this package is billed as 300 EA, is this product related?
- Eli Lilly confirmed that this is a refill kit intended to be used with Tempo smart system which includes insulin
- This is a revised kit that will be listed as a new product with a new NDC on the kit
- The package currently marketed with a BU of 300 EA will be revised with a new NDC to avoid confusion
- Agreement of a kit with a BU assignment of 1 EA per section 5.5.1 of the BUS.
A motion was made and seconded to classify the BU=EA per section 5.5.1 of the BUS with a package quantity of 1 due to the gauze pads included in the package for the Tempo™ Refill Kit.