The National Council for Prescription Drug Programs, which maintains the Telecommunication Standard for electronic, real-time prescription claims billing, published guidance on how to use Telecom for pharmacist service claims. The standard recognizes the "coming of age" of payment for pharmacy services and while it supports simplified billing and timely payment of claims, pharmacy owners should pay attention to the information expected to come from health plans and PBMs regarding these service claims (sometimes referred to as “S transactions”).
NCPA encourages all pharmacy owners to carefully read and compare service opportunities, payment rates and reconciliation scenarios against existing medical service billing models and opportunities before agreeing to any PBM service billing contracts. NCPA will continue to fight for service payment parity regardless of which technical pathway billing for pharmacists’ services may be required by health plans.
