Texas HHS Vendor Drug Vendor Reminder: "Quantity Prescribed" Required for Schedule II Drugs Beginning Sept. 21
September 2, 2020

Beginning Sept. 21, 2020, VDP will require the "Quantity Prescribed" field (460–ET) on all pharmacy claims for Schedule II drugs.

CMS published a final rule on Jan. 24, 2020
‘‘Administrative Simplification: Modification of the Requirements for the Use of Health Insurance Portability and Accountability Act of 1996 National Council for Prescription Drug Programs D.0 Standard’’
requiring the “Quantity Prescribed” field (460–ET) when processing pharmacy claims for Schedule II drugs. The final rule applies to all health insurance plans, including Medicaid and CHIP. txvendordrug.com/about/news/202….
Office of the Secretary
45 CFR Part 162 [CMS–0055–F] RIN 0938–AT52
Administrative Simplification: Modification of the Requirements for the Use of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) D.0 Standard
AGENCY: Office of the Secretary, HHS. ACTION: Final rule.
“The modification enables covered entities to distinguish whether a prescription is a ‘‘partial fill,’’ where less than the full amount prescribed is dispensed, or a refill, where the full amount prescribed is dispensed, in the HIPAA retail pharmacy transactions.”
“This modification is important to ensure the availability of a greater quantum of data that may help prevent impermissible refills of Schedule II drugs, which will help to address the public health concerns associated with prescription drug abuse in the United States.”
In the era of DEA ⬇️ production of opioids, ⬆️ administrative hoops are implemented for pharmacies to document “partial refills” being billed as “full refills” 2 prevent diversion/fraudulent billing. How many pts received partial fills- but were in fact, billed for a full RX?
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