How NCPDP Standards Streamline Prior Authorization, Medication Access

The prior authorization process has long been one of pharmacy’s most persistent pain points. However, a sweeping new rule proposed by the Centers for Medicare and Medicaid Services (CMS), backed by longstanding NCPDP standards, may finally be poised to change that.

“ When you go to your pharmacy counter, you know what your copay is in seconds, and those are powered by our 3 standards that are also named in the CMS proposed rule: Formulary and Benefit, Real-Time Prescription Benefit, and our SCRIPT standard,” Julia Vu, PharmD, executive vice president of public policy and professional relations at NCPDP, told Drug Topics®. “Whether we are in our doctor’s visit, while [pharmacists are] in front of the EHR, our standards can flow through there into the pharmacy.”

In this interview, Vu breaks down how NCPDP’s core standards are already powering the split-second copay lookups pharmacists and patients rely on at the point-of-care every day.

Now, with the CMS-proposed rule extending those same capabilities to the full prior authorization workflow for medications, the vision is a seamless, end-to-end experience that follows a patient from the physician’s office straight through to the pharmacy counter. This, more importantly, comes with defined turnaround times that bring real accountability to a process notorious for delays.

But prior authorization is only part of this conversation.

The rapid growth of direct-to-consumer (DTC) prescription programs is raising new and urgent questions about safety, transparency, and how cash-pay medications, including GLP-1s purchased through e-commerce platforms, get integrated into a patient’s broader medication profile.

For pharmacists navigating both the regulatory and clinical dimensions of these shifts, this conversation offers a front-row look at where the standards that power pharmacy practice are heading next and why it matters for every patient who walks through a pharmacy’s door.

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