In late 2024, the U.S. Department of Health and Human Services (HHS) named National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Version F6 in the Final Rule "Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard"). To read the full rule, click here. This long-anticipated update is set to modernize claims processing, prior authorization, eligibility verification, controlled substance claims processing, and other critical transactions in pharmacy workflows. While the compliance deadline is set for February 11, 2028, organizations should not be lulled into a false sense of security. This transition is complex and requires careful planning, testing, and execution well in advance.
The NCPDP Telecommunication Standard Version F6 introduces a range of improvements aimed at enhancing data accuracy, interoperability, and patient safety. Key updates include:
By standardizing these elements, Version F6 ensures a more precise, efficient, and transparent pharmacy transaction process—ultimately leading to better patient outcomes and reduced administrative burden.
Although the compliance deadline is 2028, organizations must act now to ensure a smooth transition. Adopting a new version of the NCPDP standard isn’t as simple as flipping a switch. The changes will impact a broad range of stakeholders, including:
Each of these entities must assess the impact on internal systems, workflows, compliance policies, and external partnerships. Testing, implementation, and staff training must all be accounted for in a well-orchestrated transition plan.
Point-of-Care Partners (POCP) has extensive experience in health IT, standards, regulatory compliance, and implementation support making us the ideal partner for organizations looking to successfully transition to NCPDP Version F6. We understand that compliance is not just an IT project, it’s an enterprise-wide transformation. We have experience developing and implementing plans that will ensure cost-effective compliance with the regulation on time, on budget and with minimal operational disruptions.
While implementing the standard, we have found that it also brings opportunities for greater automation and interoperability between systems and the ability to remain compliant with regulatory rules such as:
o More detailed fields for drug costs
o Improved controlled substance claims information
o Better differentiation between various types of fees
We recommend breaking down the work to reach compliance into this three-phase approach. Rather than getting overwhelmed, this phased approach helps organize the work into more manageable bites to prepare, plan, and execute their transition to the F6 standard:
Phase 1: Discovery & Readiness Assessment |
Phase 2: Implementation Planning |
Phase 3: Execution & Support
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Deep dive into enterprise operations, system dependencies, and compliance gaps related to Version F6. This includes: |
Using insights from Phase 1, internal teams with smart, objective partners develop a customized action plan |
Requires strong program management, stakeholder coordination, and compliance support to ensure a successful go-live: |
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The transition to NCPDP Telecommunication Standard Version F6 will reshape the pharmacy landscape. Waiting too long to begin preparations could lead to operational disruptions, compliance penalties, and unnecessary costs. Many stakeholders plan to go live up to 8 months before the compliance deadline to allow for a transition period to address any hiccups.
POCP is ready to help organizations navigate this transition with confidence, ensuring compliance while optimizing workflows, minimizing disruptions, and positioning teams for success.
Let’s start planning today. Reach out to POCP to discuss how we can help your organization achieve a smooth, compliant, and efficient transition to NCPDP Version F6.