Standards - Standards QUIC Form Resolutions

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199708

Desquam-X Bar 10% 3.75 oz.

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QUIC FORM 199708 Desquam-X Bar 10% 3.75 oz. Resolution

The work group decided that "A BAR OF SOAP" should be considered as ONE EACH in the standard. Since a bar of soap is only sold in this form and is not dispensed (or cut-up) as a gram in the pharmacies. Medi-Span has agreed with this determination and will change their database to reflect ONE EACH, as First Data Bank & Red Book has it listed. The standard will further define a bar of soap as an example under the definition of EACH.

199707

Lovenox 40mg prefilled syringe

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QUIC FORM 199707 Lovenox 40mg prefilled syringe Resolution

A per syringe is non-standard. Changing this product to read one each syringe is inconsistent with the standard. The standard recognizes this product as a liquid, since this is the form in which the manufacturer packaged it. The work group determined that at this time no exception to the standard would be made and this product would continue to be viewed as a ML. The pricing compendia present at the work group, First Data Bank, Medi-Span & Red Book agreed that this product should be listed as .3 ML and .4 ML respectively. This is an issue regarding rounding procedures necessitated by the non-use of metric decimal quantities.

199706

Lovenox 30mg prefilled syringe

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QUIC FORM 199706 Lovenox 30mg prefilled syringe Resolution

199705

Copaxone

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QUIC FORM 199705 Copaxone Resolution

The unit for Copaxone will remain as 32 each. However, Dave Frobel of Caremark wanted the group to address his companies billing concerns as some payers will not pay for the days supply of 32 if that exceeds the maximum on their plan. Caremark feels that because the product is a kit, they cannot break it up to dispense it because of the three different components in it. Dave Frobel asked the group to give suggestions on how to deal with this issue.

Linda Schock stated that HMR was considering changing the quantity due to this problem. However, the issue remains until such time as HMR changes the quantity. The group suggested that Caremark go back to the payers who are rejecting the claims and work with them on an individual basis to see if the pharmacist can receive prior authorization. It was suggested that Caremark ask the manufacturer, HMR, to tell the payers that the product needs to be dispensed as a kit, due in part to the fact that it is frozen. The group also felt that Caremark could use the fact that they had come to NCPDP's Work Group 2 to demonstrate that they are making good faith efforts to resolve the issue.

199704

Intron A

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QUIC FORM 199704 Intron A Resolution

Ed Edelstein, a representative of First Data Bank, agreed to change the unit of measurement of one kit to six each. According to the standard a kit is described as two different or discreet items in the same package, intended for dispensing as a unit. Ed Edelstein also mentioned a similar item, Copaxone, by the manufacturer, Hoescht Marion Rousell, which was also entered into the First Data Bank database as a one kit and will be changed to be consistent with Medi-Span and Medical Economics (Red Book) and to comply with the standard to 32 each.

199703

FRAGMIN (dalteparin sodium injection)

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QUIC FORM 199703 FRAGMIN (dalteparin sodium injection) Resolution

The work group members agreed that we couldn't make exceptions to the basic requirement of the Standard document. Injectables in liquid form whether in a vial, ampule, or syringe are always considered to be "milliliters". Changing a product to an "each" because it has a metric decimal quantity is not going to solve the problem. This will only compound the problem, because in fixing one situation, we create chaos by violating the Standard. When there is no consistency, there is no Standard.

In addition, this is not really a billing unit issue; it is a metric decimal quantity issue. The work group is trying very hard to resolve the metric decimal problem.

In the case of FRAGMIN, if HCFA is rounding the .2ml to 1 (which is what we believe they do with quantities less than 1), they are using 1 as the quantity anyway. This makes your concern (with this particular product) disappear.

WG2 Product Identification considered your requests and voted to deny the exception to the Standard for the reasons stated above.

199702

Fragmin (Dalteparin Sodium Injection)

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QUIC FORM 199702 Fragmin (Dalteparin Sodium Injection) Resolution

In addition, this is not really a billing unit issue; it is a metric decimal quantity issue. The work group is trying very hard to resolve the metric decimal problem.

WG2 Product Identification considered your requests and voted to deny the exception to the Standard for the reasons stated above.

199701

Metaproterenol Sulfate (Example)

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QUIC FORM 199701 Metaproterenol Sulfate (Example) Resolution

Ed Edelstein reviewed the QUIC #970001, which was reviewed at the task group level during the May 1997 meeting. Ed Edelstein presented the group with the actual language of the QUIC request and told the group that the task group voted to expand the definition in the standard.

Ed Edelstein presented the expanded definitions and explained about the multiples of units in metric decimal that need to be rounded up. Example: 2 units with 3.5 grams = 4.0 grams X 2 = 8. Two examples of the necessary recalculation of the unit prices were also included. Ed Edelstein also explained that this expanded definition would now go to MC for approval, with final approval by the Board of Trustees.

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